A new pouch reconstruction method after total gastrectomy (pouch-double tract method) improved the postoperative quality of life of patients with gastric cancer. Langenbecks Arch Surg. 2011;396:777-781. [PMID: 21448726 DOI: 10.1007/s00423-011-0779-6]

Comparative analysis of two digestive tract reconstruction methods in total laparoscopic radical total gastrectomy

BACKGROUND

The incidence of gastric cancer has significantly increased in recent years. Surgical resection is the main treatment, but the method of digestive tract reconstruction after gastric cancer surgery remains controversial. In the current study, we sought to explore a reasonable method of digestive tract reconstruction and improve the quality of life and nutritional status of patients after surgery. To this end, we statistically analyzed the clinical results of patients with gastric cancer who underwent jejunal interposition double-tract reconstruction (DTR) and esophageal jejunum Roux-en-Y reconstruction (RY).

AIM

To explore the application effect of DTR in total laparoscopic radical total gastrectomy (TLTG) and evaluate its safety and efficacy.

METHODS

We collected the relevant data of 77 patients who underwent TLTG at the Fourth Hospital of Hebei Medical University from October 2021 to January 2023. Among them, 35 cases were treated with DTR, and the remaining 42 cases were treated with traditional RY. After 1:1 propensity score matching, the cases were grouped into 31 cases per group, with evenly distributed data. The clinical characteristics and short- and long-term clinical outcomes of the two groups were statistically analyzed.

RESULTS

The two groups showed no significant differences in basic data, intraoperative blood loss, number of lymph node dissections, first defecation time after operation, postoperative hospital stay, postoperative complications, and laboratory examination results on the 1st, 3rd, and 5th days after operation. The operation time of the DTR group was longer than that of the RY group [(307.58 ± 65.14) min vs (272.45 ± 62.09) min, P = 0.016], but the first intake of liquid food in the DTR group was shorter than that in the RY group [(4.45 ± 1.18) d vs (6.0 ± 5.18) d, P = 0.028]. The incidence of reflux heartburn (Visick grade) and postoperative gallbladder disease in the DTR group was lower than that in the RY group (P = 0.033 and P = 0.038). Although there was no significant difference in body weight, hemoglobin, prealbumin, and albumin between the two groups at 1,3 and 6 months after surgery, the diet of patients in the DTR group was better than that in the RY group (P = 0.031).

CONCLUSION

The clinical effect of DTR in TLTG is better than that of RY, indicating that it is a more valuable digestive tract reconstruction method in laparoscopic gastric cancer surgery.

The clinical effectiveness of the method by establishing a proximal jejunum pouch after laparoscopic total gastrectomy: A propensity score-based analysis

BACKGROUND

In this study, we propose an improved Roux-en-Y (RY) surgical method by constructing a proximal jejunum pouch (PP-RY). Postoperative results were evaluated among patients with gastric cancer who underwent PP-RY and standard RY anastomosis.

METHODS

The clinical data of patients with gastric cancer who underwent laparoscopic total gastrectomy (LTG) in our center from May 2019 to May 2020 were collected retrospectively. We compared the short-term results of patients in the PP-RY and RY groups using 1:1 propensity score matching (PSM).

RESULTS

A total of 317 patients were selected, including those who received RY (n = 249) or PP-RY (n = 68) after LTG. After PSM, both groups had a sample size of 68. During the one-year follow-up period, the incidences of postoperative dumping syndrome (5.6%) and reflux esophagitis (14.8%) were significantly lower in the PP-RY group (P = 0.001 and P = 0.010, respectively). Weight loss (6.5 ± 2.0 kg) and albumin decrease (0.2 ± 0.1 g/dl) were significantly lower (P = 0.038 and P < 0.001, respectively), and the prognostic nutritional index (PNI) was significantly higher in the PP-RY group (P = 0.009). In the QLQ-C30 scale, the degree of anorexia in the PP-RY group was significantly lower than that in the RY group (P＜0.05). In the QLQ-STO22 scale, chest and abdomen pain, dietary restriction, and anxiety were significantly lower in the PP-RY group (all P＜0.05).

CONCLUSION

PP-RY can lead to obvious improvements in nutritional status, reduce short-term complications, and improve quality of life (QoL) for patients after LTG.

Influencing Factors and Effects of Treatment on Quality of Life in Patients With Gastric Cancer-A Systematic Review

Background: Gastric cancer (GC) is one of the leading causes of death worldwide. It is associated with several disease-related impairments contributing to the psycho-social burden of those patients, such as deterioration of well-being and overall quality of life (QOL). The aim of this study is to present the wide range of factors potentially impacting patients' overall well-being and possible preventive interventions. Methods: This systematic review was conducted in October 2020 with a search in the PubMed, MedLine, PsycInfo, and Google Scholar databases. We used the keywords "gastric cancer," "gastric neoplasm," and each of them combined with "quality of life," "depression," and "anxiety" to identify all relevant articles reporting about potential impact factors influencing the overall well-being of patients suffering from gastric cancer. Results: Finally, 125,490 articles were found, of which 125,431 were excluded in several steps of screening. Inclusion criteria were studies carried out on human ≥18 years of age, studies in English or German language, clinical trials, registry-based studies, cohort studies, population-based studies, and certain titles and abstracts. After screening for eligibility 35 potential factors influencing overall well-being in patients with GC were identified and classified into 9 important categories: genetic condition, treatment method, blood markers, nutritional status, daily living, state of health, mental state, supportive care, and alternative treatment. Conclusion: Since various factors are involved in the development of patients' overall well-being, timely treatment of psycho-social impairments by physicians and psychologists is of enormous importance. Preventing psycho-social burden by improving patients' QOL should be of high importance in the treatment regimen of patients with GC.

A Comparative Study of Double-Tract Reconstruction and Roux-en-Y After Gastrectomy for Gastric Cancer

BACKGROUND

The meta-analysis was performed to compare surgical and functional results of double-tract (DT) and Roux-en-Y (RY) reconstruction, applied in both partial and total gastrectomy.

METHODS

PubMed, Ovid, Web of Science, Wiley, EBSCO, and the Cochrane Library Central were searched for studies comparing DT and RY after partial or total gastrectomy. Surgical, nutritional, and long-term outcomes were collected and analyzed.

RESULTS

A total of 595 patients from 8 studies were included. Operative time, time to first flatus, length of hospital stays, complications, postoperative nutritional variables, and functional result were similar between 2 groups. Group DT had significantly less blood loss, shorter time to oral intake and less loss of body weight at 2 years after operation.

CONCLUSIONS

DT reconstruction is comparable with RY after gastrectomy in safety, surgical outcomes including reflux symptom and postoperative recovery and shows better food intake and body weight maintenance.

Self-expandable metal stents in patients with postoperative delayed gastric emptying after distal gastrectomy

AIM

To investigate the efficacy and safety of endoscopic stent insertion in patients with delayed gastric emptying after gastrectomy.

METHODS

In this study, we prospectively collected data from patients who underwent stent placement for delayed gastric emptying (DGE) after distal gastrectomy between June 2010 and April 2017, at a tertiary referral academic center. Clinical improvement, complications, and consequences after stent insertion were analyzed.

RESULTS

Technical success was achieved in all patients (100%). Early symptom improvement was observed in 15 of 20 patients (75%) and clinical success was achieved in all patients. Mean follow-up period was 1178.3 ± 844.1 d and median stent maintenance period was 51 d (range 6-2114 d). During the follow-up period, inserted stents were passed spontaneously per rectum without any complications in 14 of 20 patients (70%). Symptom improvement was maintained after stent placement without the requirement of any additional intervention in 19 of 20 patients (95%).

CONCLUSION

Endoscopic stent placement provides prompt relief of obstructive symptoms. Thus, it can be considered an effective and safe salvage technique for post-operative DGE.

Reconstruction with Jejunal Pouch after Gastrectomy for Gastric Cancer

The construction of a gastric substitute pouch after gastrectomy for gastric cancer has been proposed to help ameliorate postprandial symptoms and nutritional performance. Adequate reconstruction after gastrectomy is an important issue, because postoperative patient quality of life (QOL) primarily depends on the reconstruction method. To this end, jejunal pouch (JP) reconstructions were developed to improve the patient's eating capacity and QOL by creating large reservoirs with improved reflux barriers to prevent esophagitis and residual gastritis. It is important that such reconstructions also preserve blood and extrinsic neural integrity for maintaining pouch function, because JP motility is associated directly with QOL. Some problems remain to be resolved with the JP reconstructions method including gastrointestinal motility, which plays a major role in food transfer, digestion, and absorption of nutrients. Further studies including basic research and larger prospective randomized control trials are also needed to obtain definitive results. With persistent innovations in surgical techniques, JP after gastrectomy could become a safe and preferable reconstructive modality to improve patient QOL after gastrectomy.

Current status of randomized controlled trials for laparoscopic gastric surgery for gastric cancer in Korea

Laparoscopic gastrectomy for gastric cancer has rapidly gained popularity as a result of the increased incidence of early gastric cancer in Korea. Although laparoscopic gastrectomy has been considered as an investigational treatment because of the lack of solid evidence of efficacy and safety, it is increasingly regarded as a standard treatment for early gastric cancer. Moreover, solid evidence is anticipated from two studies in Korea, KLASS 01 and KLASS 02, the latter of which examines the suitability of laparoscopic gastrectomy for advanced gastric cancer. The use of cutting-edge techniques for laparoscopic gastrectomy enables surgeons to deliver various treatment options that offer the best possible quality of life after gastrectomy. In this review, we summarize the current status of clinical trials on laparoscopic gastrectomy in Korea and examine future perspectives regarding laparoscopic gastrectomy for the treatment of gastric cancer.

Comprehension of readmission after laparoscopy assisted distal gastrectomy: what are the causes?

Purpose

The aim of this study is to evaluate long-term outcomes regarding readmission for laparoscopy-assisted distal subtotal gastrectomy (LADG) compared to conventional open distal subtotal gastrectomy (CODG) for early gastric cancer (EGC).

Methods

Between January 2003 and December 2006, 223 and 106 patients underwent LADG and CODG, respectively, for EGC by one surgeon. The clinicopathologic characteristics, postoperative outcomes, postoperative complications, overall 5-year survival, recurrence, and readmission were retrospectively compared between the two groups.

Results

Multiple readmission rate in LADG was significantly less than that in CODG (0.4% vs. 3.8%, P = 0.039), although the readmission rate, reoperation rate after discharge, and mean readmission days were not significantly different between the two groups. Readmission rates of the LADG and CODG groups were 12.6% and 14.2%, respectively. First flatus time and postoperative hospital stay was significantly shorter in the LADG group. However, there was no significant difference in the complication rates between the two groups. Overall 5-year survival rates of the LADG and CODG group were 100% and 99.1% (P = 0.038), respectively.

Conclusion

Compared to the CODG group, the LADG group has several advantages in surgical short-term outcome and some benefit in terms of readmission in surgical long-term outcome for patients with EGC, even though the oncologic outcome of LADG is similar to that of CODG over 5 years.

Readmissions following elective radical total gastrectomy for early gastric cancer: a case-controlled study

BACKGROUND

Readmission after gastrectomy is one of the factors that reflect quality of life. Therefore, we analyzed the several factors related to readmissions after total gastrectomy for early gastric cancer.

METHODS

From January 2002 through December 2009, 102 consecutive patients who underwent radical total gastrectomy for early gastric cancer were enrolled in this study. We evaluated the incidence, cause, time point, and type of treatment for readmission after discharge; we compared the readmission and non-readmission groups in regard to clinicopathologic features and postoperative outcomes.

RESULTS

The readmission rate during the five years after total gastrectomy was 22 of 102 (21.6%). The most common cause for readmission was esophagojejunostomy stricture (5 cases). The treatment given for 31 readmissions included 23 conservative therapies, 3 radiologic or endoscopic interventions, and 5 re-operations. No significant differences were detected in the clinicopathologic feature, postoperative outcomes, or 5-year survival rates between the readmission and non-readmission group. No specific risk factor was found to be associated with readmission.

CONCLUSION

Although we could not determine a specific risk factor associated with readmission after radical total gastrectomy, prevention of readmission by evaluating the causes and treatments after radical total gastrectomy can improve the patient's quality of life.

A 5 year analysis of readmissions after radical subtotal gastrectomy for early gastric cancer

BACKGROUND

Many patients and surgeons have become interested in the quality of life after surgery for early gastric cancer. However, no reports on readmission rates for gastrectomy patients have been published, even if readmission greatly affects the patient's quality of life.

METHODS

In 530 consecutive early gastric cancer patients who underwent radical subtotal gastrectomy, we determined the incidence, cause, timing, type of treatment, and risk factors for readmission after discharge, and compared the readmission and nonreadmission groups with respect to clinicopathologic features and postoperative outcomes.

RESULTS

Overall, the 5 year and 1 month readmission rates after radical subtotal gastrectomy for early gastric cancer were 13.0% (69 of 530) and 7.5% (40 of 530), respectively. The most common cause for readmission was delayed gastric emptying (17 cases). Among a total of 82 readmissions, 34 patients (41.5%) were readmitted within 2 weeks of surgery. The type of treatment for 82 readmissions included 55 conservative therapies, 15 radiologic or endoscopic interventions, and 12 repeat laparotomies. No significant differences were detected in the clinicopathologic feature and postoperative outcomes between the two groups. The initial hospital stay remained significantly associated with readmission based on multivariate analysis.

CONCLUSIONS

Readmission rate at 1 month after radical subtotal gastrectomy is lower than that after major bowel surgery. Unusual postoperative recovery in a patient with vague symptoms should be managed with greater care before discharge. After subtotal gastrectomy for early gastric cancer, prevention of readmission can improve the patient's quality of life.