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Chen YX, Huang QZ, Wang PC, Zhu YJ, Chen LQ, Wu CY, Wang JT, Chen JX, Ye K. Short- and long-term outcomes of Roux-en-Y and Billroth II with Braun reconstruction in total laparoscopic distal gastrectomy: a retrospective analysis. World J Surg Oncol 2023; 21:361. [PMID: 37990273 PMCID: PMC10664253 DOI: 10.1186/s12957-023-03249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND The controversy surrounding Roux-en-Y (R-Y) and Billroth II with Braun (BII + B) reconstruction as an anti-bile reflux procedure after distal gastrectomy has persisted. Recent studies have demonstrated their efficacy, but the long-term outcomes and postoperative quality of life (QoL) among patients have yet to be evaluated. Therefore, we compared the short-term and long-term outcomes of the two procedures as well as QoL. METHODS The clinical data of 151 patients who underwent total laparoscopic distal gastrectomy (TLDG) at the Gastrointestinal Surgery Department of the Second Hospital of Fujian Medical University from January 2016 to December 2019 were retrospectively analyzed. Of these, 57 cases with Roux-en-Y procedure (R-Y group) and 94 cases with Billroth II with Braun procedure were included (BII + B group). Operative and postoperative conditions, early and late complications, endoscopic outcomes at year 1 and year 3 after surgery, nutritional indicators, and quality of life scores at year 3 postoperatively were compared between the two groups. RESULTS The R-Y group recorded a significantly longer operative time (194.65 ± 21.52 vs. 183.88 ± 18.02 min) and anastomotic time (36.96 ± 2.43 vs. 27.97 ± 3.74 min) compared to the BII + B group (p < 0.05). However, no other significant differences were observed in terms of perioperative variables, including blood loss (p > 0.05). Both groups showed comparable rates of early and late complications. Endoscopic findings indicated similar food residuals at years 1 and 3 post-surgery for both groups. The R-Y group had a lower occurrence of residual gastritis and bile reflux at year 1 and year 3 after surgery, with a statistically significant difference (p < 0.001). Reflux esophagitis was not significantly different between the R-Y and BII + B groups in year 1 after surgery (p = 0.820), but the R-Y group had a lower incidence than the BII + B group in year 3 after surgery (p = 0.023). Nutritional outcomes at 3 years after surgery did not differ significantly between the two groups (p > 0.05). Quality of life scores measured by the QLQ-C30 scale were not significantly different between the two groups. However, on the QLQ-STO22 scale, the reflux score was significantly lower in the R-Y group than in the BII + B group (0 [0, 0] vs. 5.56 [0, 11.11]) (p = 0.003). The rest of the scores were not significantly different (p > 0.05). CONCLUSION Both R-Y and B II + B reconstructions are equally safe and efficient for TLDG. Nevertheless, the R-Y reconstruction reduces the incidence of residual gastritis, bile reflux, and reflux esophagitis, as well as postoperative reflux symptoms, and provides a better quality of life for patients. R-Y reconstruction is superior to BII + B reconstruction for TLDG.
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Affiliation(s)
- Yan-Xin Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Qiao-Zhen Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Peng-Cheng Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yue-Jia Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Li-Quan Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jin-Tian Wang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Jun-Xing Chen
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, No. 950 Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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Yu Z, Zhao X, Gao Y, Gao J, Li P, Liu N. Early Outcomes of Different Reconstruction Procedures in Radical Distal Gastrectomy: A Retrospective Propensity Score Matching Study. Surg Laparosc Endosc Percutan Tech 2023; 33:515-521. [PMID: 37678237 DOI: 10.1097/sle.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate the short-term effects of Billroth I (B-I), Billroth Ⅱ (B-Ⅱ), Billroth Ⅱ+Braun (B-B), and Roux-en-Y (R-Y) reconstruction procedures in radical distal gastrectomy using propensity score matching (PSM). MATERIALS AND METHODS The clinical data of 1994 patients who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Subsequently, PSM analyses were performed 3 times on the 4 reconstruction procedures, and the matching capacity was set to 0.01. Data regarding control variables and outcome indicators obtained using PSM were compared and analyzed. RESULTS Compared with the other reconstruction procedures, patients in the B-I group had shorter operation time ( P =0.002), fewer abdominal drainage tubes ( P <0.001), and a lower risk of postoperative gastroparesis ( P =0.001) and gastrointestinal bleeding ( P =0.034), but tended to experience a longer postoperative indwelling time of bladder catheter ( P <0.001), gastrointestinal decompression ( P <0.001), fasting ( P =0.001), and hospital stays ( P =0.005). The B-B group tended to have fewer applications of the abdominal drainage tube ( P =0.014), a lower risk of postoperative gastrointestinal fistula ( P =0.040), shorter postoperative time of gastrointestinal decompression ( P =0.043), fasting ( P <0.001), and a shorter hospital stay ( P <0.001) than the R-Y group. Furthermore, the B-B group had a shorter postoperative time for gastrointestinal decompression ( P =0.014) and fasting ( P <0.001) than the B-Ⅱ group. CONCLUSION Billroth I reconstruction has the advantages of simple operation, short operative time, and few early complications, but tends to result in a long recovery time during postoperative hospitalization. The B-B operation is associated with faster postoperative recovery than the R-Y or B-Ⅱ operation.
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Affiliation(s)
- Zhiyuan Yu
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Xudong Zhao
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yunhe Gao
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingwang Gao
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Peiyu Li
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Na Liu
- Medical School of Chinese PLA, Beijing, China
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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Yang K, Zhang W, Chen Z, Chen X, Liu K, Zhao L, Hu J. Comparison of long-term quality of life between Billroth-I and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a randomized controlled trial. Chin Med J (Engl) 2023; 136:1074-1081. [PMID: 37014767 PMCID: PMC10228481 DOI: 10.1097/cm9.0000000000002602] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The results of studies comparing Billroth-I (B-I) with Roux-en-Y (R-Y) reconstruction on the quality of life (QoL) are still inconsistent. The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer. METHODS A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital, Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group ( N = 70) and R-Y group ( N = 70). The follow-up time points were 1, 3, 6, 9, 12, 24, 36, 48, and 60 months after the operation. The final follow-up time was May 2019. The clinicopathological features, operative safety, postoperative recovery, long-term survival as well as QoL were compared, among which QoL score was the primary outcome. An intention-to-treat analysis was applied. RESULTS The baseline characteristics were comparable between the two groups. There were no statistically significant differences in terms of postoperative morbidity and mortality rates, and postoperative recovery between the two groups. Less estimated blood loss and shorter surgical duration were found in the B-I group. There were no statistically significant differences in 5-year overall survival (79% [55/70] of the B-I group vs. 80% [56/70] of the R-Y group, P = 0.966) and recurrence-free survival rates (79% [55/70] of the B-I group vs. 78% [55/70] of the R-Y group, P = 0.979) between the two groups. The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences (postoperative 1 year: 85.4 ± 13.1 vs . 88.8 ± 16.1, P = 0.033; postoperative 3 year: 87.3 ± 15.2 vs . 92.8 ± 11.3, P = 0.028; postoperative 5 year: 90.9 ± 13.7 vs . 96.4 ± 5.6, P = 0.010), and the reflux (postoperative 3 year: 8.8 ± 12.9 vs . 2.8 ± 5.3, P = 0.001; postoperative 5 year: 5.1 ± 9.8 vs . 1.8 ± 4.7, P = 0.033) and epigastric pain (postoperative 1 year: 11.8 ± 12.7 vs. 6.1 ± 8.8, P = 0.008; postoperative 3 year: 9.4 ± 10.6 vs. 4.6 ± 7.9, P = 0.006; postoperative 5 year: 6.0 ± 8.9 vs . 2.7 ± 4.6, P = 0.022) were milder in the R-Y group than those of the B-I group at the postoperative 1, 3, and 5-year time points. CONCLUSIONS Compared with B-I group, R-Y reconstruction was associated with better long-term QoL by reducing reflux and epigastric pain, without changing survival outcomes. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-10001434.
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Affiliation(s)
- Kun Yang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weihan Zhang
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zehua Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiaolong Chen
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Kai Liu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Linyong Zhao
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiankun Hu
- Department of General Surgery & Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Otake R, Kumagai K, Ohashi M, Makuuchi R, Ida S, Sano T, Nunobe S. Reflux Esophagitis After Laparoscopic Pylorus-Preserving Gastrectomy for Gastric Cancer. Ann Surg Oncol 2023; 30:2294-2303. [PMID: 36509874 DOI: 10.1245/s10434-022-12902-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/12/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Laparoscopic pylorus-preserving gastrectomy (LPPG) is performed for cT1N0 gastric cancer as a function-preserving surgery, but reflux esophagitis can develop as a mid- to long-term complication postoperatively. We aimed to clarify the incidence rate of this complication and the factors correlated with it. METHODS Patients with gastric cancer who underwent LPPG between 2005 and 2017 were analyzed. Postoperative reflux esophagitis was evaluated with esophagogastroduodenoscopy; patients were diagnosed as having reflux esophagitis with erosive esophagitis using the modified Los Angeles classification. The incidence rate of postoperative reflux esophagitis was estimated; factors correlated with postoperative reflux esophagitis were analyzed using the logistic regression model. RESULTS During the study period, 813 patients underwent LPPG for gastric cancer, and 127 (15.6%) of them developed grade B or more severe postoperative reflux esophagitis. The factors correlated with postoperative reflux esophagitis were male sex (odds ratio, 2.68; 95% confidence interval, 1.77-4.05; P < 0.001), preoperative grade A reflux esophagitis (odds ratio, 3.05; 95% confidence interval, 1.28-7.27; P = 0.012), body mass index of ≥ 23 kg/m2 at 1 year postoperatively (odds ratio, 2.18; 95% confidence interval, 1.34-3.53; P = 0.002), postoperative hiatal hernia (odds ratio, 4.35; 95% confidence interval, 2.35-8.04; P < 0.001), and long-term stasis (odds ratio, 1.58; 95% confidence interval, 1.01-2.47; P = 0.044). CONCLUSIONS Careful attention should be paid in performing LPPG and in postoperative management after LPPG for gastric cancer patients with those risk factors.
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Affiliation(s)
- Reiko Otake
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
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Roux-en-Y reconstruction alleviates radical gastrectomy-induced colitis via down-regulation of the butyrate/NLRP3 signaling pathway. EBioMedicine 2022; 86:104347. [PMID: 36371983 PMCID: PMC9664480 DOI: 10.1016/j.ebiom.2022.104347] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/06/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Different methods for digestive tract reconstruction have a complex impact on the nutritional status of gastric cancer (GC) patients after radical gastrectomy. Previous studies reported that Roux-en-Y (R-Y) reconstruction resulted in obvious weight reduction and improvement in type 2 diabetes in obese patients. We investigated the relationship between R-Y reconstruction, gut microbiota, and the NLRP3 inflammasome in GC patients with poor basic nutrition. METHODS Changes in the gut microbiota after radical gastrectomy accomplished by different methods of digestive tract reconstruction were investigated via fecal microbiota transplantation. The underlying mechanisms were also explored by analyzing the role of the microbiota, butyrate, and the NLRP3 inflammasome in the colon tissues of colitis model mice and GC patients after radical gastrectomy. FINDINGS R-Y reconstruction effectively relieved intestinal inflammation and facilitated nutrient absorption. 16S rRNA analysis revealed that gavage transplantation with the fecal microbiota of R-Y reconstruction patients could reverse dysbacteriosis triggered by radical gastrectomy and elevate the relative abundance of some short-chain fatty acid (SCFA)-producing bacteria. Subsequently, butyrate negatively regulated the NLRP3-mediated inflammatory signaling pathway to inhibit the activation of macrophages and the secretion of pro-inflammatory mediators such as caspase-1 and interleukin (IL)-1β, decreasing the level of intestinal inflammation and promoting nutrient absorption. INTERPRETATION R-Y reconstruction induced colonization with SCFA-producing bacteria to alleviate radical gastrectomy-induced colitis by down-regulating the NLRP3 signaling pathway. This can be a new strategy and theoretical basis for the management of the postoperative nutritional status of GC patients. FUNDING This work was supported by the National Nature Science Foundation of China (81974375), the BoXi cultivation program (BXQN202130), and the Project of Youth Foundation in Science and Education of the Department of Public Health of Suzhou (KJXW2018001).
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Comparison of the gastric microbiome in Billroth I and Roux-en-Y reconstructions after distal gastrectomy. Sci Rep 2022; 12:10594. [PMID: 35732881 PMCID: PMC9217802 DOI: 10.1038/s41598-022-14886-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/14/2022] [Indexed: 11/25/2022] Open
Abstract
The changes in gastric microbiota following reconstruction after gastrectomy have not been reported. This study aimed to compare the gastric microbiota following Billroth I and Roux-en-Y reconstructions after distal gastrectomy. We enrolled 71 gastrectomized patients with gastric cancer; 31 and 40 underwent Billroth I and Roux-en-Y reconstructions, respectively. During upper gastrointestinal endoscopy, gastric fluid was collected immediately before and 6 months after distal gastrectomy. Deoxyribonucleic acid isolated from each sample was evaluated using 16S ribosomal ribonucleic acid metagenomic analysis. Analysis revealed that the gastric microbiota’s species richness (expressed as the alpha diversity) was significantly lower after than before distal gastrectomy (operational taxonomic units, p = 0.001; Shannon index, p = 0.03). The interindividual diversity (beta diversity) was significantly different before and after distal gastrectomy (unweighted UniFrac distances, p = 0.04; weighted UniFrac distances, p = 0.001; Bray–Curtis, p = 0.001). Alpha and beta diversity were not significantly different between Billroth I and Roux-en-Y reconstructions (observed operational taxonomic units, p = 0.58; Shannon index, p = 0.95; unweighted UniFrac distances, p = 0.65; weighted UniFrac distances, p = 0.67; Bray–Curtis, p = 0.63). Our study demonstrated significant differences in gastric microbiota diversity, composition, and community before and after distal gastrectomy but no difference between Billroth I and Roux-en-Y reconstruction after distal gastrectomy.
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Yan Y, Wang D, Liu Y, Lu L, Wang X, Zhao Z, Li C, Liu J, Li W, Fu W. Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study. Cancer Control 2022; 29:10732748221087059. [PMID: 35412845 PMCID: PMC9121732 DOI: 10.1177/10732748221087059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Objectives Although laparoscopic distal gastrectomy has been widely used for distal
gastric cancer, the best functional reconstruction type has not yet been
established. Based on previous experience, we propose a modified uncut
Roux-en-Y anastomosis. This study aimed to compare the outcomes of different
intracorporeal anastomoses after laparoscopic distal gastrectomy. Methods From April 2015 to August 2020, the data of 215 patients who underwent
laparoscopic distal gastrectomy was collected. The patients were divided
into 4 groups according to the digestive tract reconstruction method,
Billroth-I, Billroth-II, Roux-en-Y, and the modified uncut Roux-en-Y.
Clinicopathologic characteristics, surgery details, short-term outcomes, and
postoperative nutritional status were analyzed. Results The operation time of Billroth-I anastomosis was significantly shorter (216.2
± 25.8 min, P < .001) than that of other methods. There was no difference
in postoperative complications and OS among the 4 reconstruction methods.
The incidences of esophagitis, gastritis, and bile reflux were significantly
lower in the Roux-en-Y and uncut Roux-en-Y group (P < .001) 1 year after
surgery. And the postoperative albumin and PNI levels in uncut Roux-en-Y
group were higher than those in other groups(P < .05). On multivariate
analysis, age and reconstruction type were independently related to
esophagitis, gastritis, and bile reflux. Serum albumin and the prognostic
nutritional index were significantly higher in the uncut Roux-en-Y group
than other groups (P < .05). Conclusions All 4 reconstruction techniques are feasible and safe. The Roux-en-Y and
uncut Roux-en-Y are superior to Billroth-Ⅰ and Billroth-Ⅱ+Braun in terms of
reflux esophagitis, gastritis, and bile reflux. Uncut Roux-en-Y may result
in better PNI than the others.
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Affiliation(s)
- Yongjia Yan
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Daohan Wang
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Yubiao Liu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Li Lu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Xi Wang
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Zhicheng Zhao
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Chuan Li
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Jian Liu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Weidong Li
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
| | - Weihua Fu
- Department of General Surgery, Tianjin General Surgery Institute, 117865Tianjin Medical University General Hospital, Tianjin, China
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Shoda K, Kubota T, Ushigome E, Konishi H, Shiozaki A, Fujiwara H, Okamoto K, Kawaguchi Y, Akaike H, Fukui M, Ichikawa D, Otsuji E. Dynamics of glucose levels after Billroth I versus Roux-en-Y reconstruction in patients who undergo distal gastrectomy. Surg Today 2021; 52:889-895. [PMID: 34817683 DOI: 10.1007/s00595-021-02404-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/06/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Recent studies have highlighted the importance of understanding trends in blood glucose levels. We examined the differences in blood glucose fluctuations according to the reconstruction method used after distal gastrectomy (DG) in patients with non-diabetic gastric cancer (GC). METHODS Sixty-one patients who underwent DG followed by either Billroth 1 (B1) or Roux-en-Y (R-Y) reconstruction were enrolled in this study. We used flash continuous glucose monitoring (CGM), a new technique for assessing glycemic control, to document the post-gastrectomy glycemic profile. Immediately before discharge, a CGM sensor was placed subcutaneously to evaluate blood glucose trends for 2 weeks. RESULTS The coefficient of variation of glucose levels was significantly higher in the Roux-en-Y (R-Y) group than in the Billroth I (B-I) group (p = 0.0260). The time below range (TBR, glucose levels of < 70 mg/dL) was also significantly higher in the R-Y group (p = 0.0115). Logistic regression analysis revealed that preoperative casual glucose levels of < 100 mg/dL and R-Y reconstruction were independently correlated with risk factors for a postoperative nocturnal TBR of > 30% (p = 0.006 and 0.042, respectively). CONCLUSION Our findings provide new insights into the post-DG reconstruction method selected for patients with non-diabetic gastric cancer by assessing postoperative blood glucose fluctuations using flash CGM.
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Affiliation(s)
- Katsutoshi Shoda
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan. .,First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
| | - Takeshi Kubota
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan.
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 6028566, Japan
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Roux-en-Y Reconstruction Following Distal Gastrectomy Reduced Endoscopic Reflux Esophagitis in Older Adults: Propensity Score–Matching Analysis. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00045.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
This study aimed to examine the functional outcomes of Roux-en-Y (RY) and Billroth I (BI) reconstruction methods following distal gastrectomy in patients ages ≥75 years with gastric cancer.
Summary of background data
RY and BI reconstructions are commonly performed after distal gastrectomy. However, no study has compared the 2 procedures in older adults.
Methods
We identified older patients who underwent RY (n = 103) or BI (n = 71) reconstruction following distal gastrectomy from 2011 to 2018 in our database. Patients in the RY and BI groups were matched by propensity scores, and each group included 62 patients. We compared short-term surgical outcomes and clinical findings at 1 year postoperatively. Additionally, risk factors for endoscopic reflux esophagitis following distal gastrectomy were evaluated.
Results
Reflux esophagitis, bile reflux, and remnant gastritis were significantly less frequent in RY reconstruction than in BI reconstruction. Moreover, both BI reconstruction and preoperative hiatus hernias were independent risk factors for postoperative endoscopic reflux esophagitis. Although the incidence of postoperative surgical complications following RY and BI was similar, RY was found to cause delayed gastric emptying more frequently than BI.
Conclusion
RY reconstruction is a favorable procedure to prevent reflux esophagitis in older patients, particularly in those with hiatal hernia.
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Zhang X, Zhang W, Yuan M, Shi X, Chen H, Feng Z, Chen Z, Liu D, Yan E, Ren S. Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy. BMC Surg 2021; 21:213. [PMID: 33902547 PMCID: PMC8077891 DOI: 10.1186/s12893-021-01207-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/14/2021] [Indexed: 01/11/2023] Open
Abstract
Background We retrospectively reviewed and consecutively collected the clinical data of distal gastric cancer patients who received surgical treatment, and we discuss the safety and feasibility of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods We reviewed the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, who underwent totally laparoscopic distal gastrectomy. During the operation, the method of double layered end-to-end anastomosis with continuous manual suture was used for Billroth type I anastomosis to complete digestive tract reconstruction. All patients have been given a follow-up visit and gastroscopy three months after the operation. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General information: male(n = 27), female(n = 14), age = 65.02(SD 9.94) years, and BMI = 23.52(SD 2.56) kg/m2, Tumor location: antrum(32,78.0%), angle (6,14.6%), and body (3,7.3%). Clinical stage: I (27, 65.9%), II (7, 17.1%), and III (7, 17.1%). Operative information: operation time = 154.51(SD 33.37) min, anastomosis time = 26.88(SD 5.11) min; intraoperative bleeding = 66.34(SD 48.81) ml; first postoperative ambulation Median = 1(IQR 0) d, first postoperative flatus Median = 3(IQR 2) d, first postoperative diet Median = 3(IQR 1) d, postoperative hospital stay Median = 7(IQR 2) d, and total hospitalization cost = 10,935.00(SD 2205.72)USD. Differentiation degree: high and high-moderate (3,7.32%), moderate and poor-moderate (24, 58.54%), poor differentiation (14, 34.15%), dissected lymph nodes Median = 31(IQR 17), and positive lymph nodes Median = 0(IQR 1). Pathological stage: IA (20, 48.78%), IB (3, 7.32%), IIA (4, 9.76%), IIB (5, 12.20%), IIIA (1, 2.44%), IIIB (3, 7.32%), and IIIC (5, 12.20%). Complications (n = 4): lung infection (1, 2.44%), anastomotic leakage (1, 2.44%), and gastroparesis (2, 4.88%). Conclusion It is safe and feasible in clinical treatment to apply the method of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.
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Affiliation(s)
- XinSheng Zhang
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - WeiBin Zhang
- General Surgery Department of Jinzhou Central Hospital, No.51, Section 2, Shanghai Road, Guta District, Jinzhou, Liaoning, China
| | - MengLang Yuan
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - XiaoMeng Shi
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - HongYi Chen
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - Zhen Feng
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - ZiHao Chen
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - DunBo Liu
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - EnJun Yan
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China
| | - ShuangYi Ren
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Zhongshan Road 467, Shahekou District, Dalian, Liaoning, China.
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11
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Features of the complications for intracorporeal Billroth-I and Roux-en-Y reconstruction after laparoscopic distal gastrectomy for gastric cancer. Langenbecks Arch Surg 2021; 406:1425-1432. [PMID: 33604820 DOI: 10.1007/s00423-021-02136-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 02/15/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Recently, the Roux-en-Y procedure (R-Y) and delta-shaped Billroth-I anastomosis (DB-I) have become prevalent as intracorporeal gastroenteric anastomosis methods after laparoscopic distal gastrectomy (LDG) for gastric cancer. However, the differences in postoperative outcomes between the two methods have not been clarified. Hence, this retrospective study aimed to reveal the features of the complications of the R-Y versus DB-I after LDG. METHODS The study cohort comprised patients with gastric cancer who underwent DB-I or R-Y after LDG from January 2013 to May 2016. Patient characteristics and surgical and postoperative variables were analyzed. To compensate for intergroup differences in baseline characteristics, estimated propensity scores were used to perform one-on-one matching between the groups. RESULTS A total of 564 patients were included, and propensity score matching created a matched cohort of 149 pairs in the DB-I and R-Y groups. The incidence of short-term complications such as gastrointestinal fistula classified as Clavien-Dindo grade IIIa or above was significantly greater in the DB-I group than the R-Y group (14.1% versus 4.7%, p=0.004). In contrast, the R-Y was associated with long-term complications such as internal hernia and tended to result in a slightly higher readmission rate in the R-Y group compared with the DB-I group (2.7% versus 6.0%, p=0.128). CONCLUSION DB-I after LDG was associated with a significantly higher rate of short-term complications compared with the R-Y, whereas characteristic long-term complications tended to be observed after the R-Y. These differences should be considered during the selection of the reconstruction method and postoperative management of LDG.
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12
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Sakaguchi M, Hosogi H, Tokoro Y, Yagi D, Shimoike N, Akagawa S, Kanaya S. Functional Outcomes of Delta-Shaped Anastomosis After Laparoscopic Distal Gastrectomy. J Gastrointest Surg 2021; 25:397-404. [PMID: 32026335 DOI: 10.1007/s11605-020-04516-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/03/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND We invented a simple and secure method of intracorporeal gastroduodenostomy, the delta-shaped anastomosis (DA), using endoscopic linear stapler only and standardized the DA procedure by resecting two-thirds of the stomach based on the anatomical landmarks. This study aimed to evaluate the feasibility of the standardized DA as the standard reconstruction procedure after a laparoscopic distal gastrectomy assessing functional outcomes including postoperative complications, body weight loss, nutritional status, and endoscopic findings. METHODS The medical records of 349 patients with gastric cancer who underwent laparoscopic distal gastrectomy from April 2011 to December 2017 at our hospital were retrospectively reviewed. Functional outcomes were assessed according to nutritional status and endoscopic findings. RESULTS The operation time was shorter and complication rate was lower in the standardized DA than those in Billroth-II (BII) and Roux-en-Y (RY). The body weight loss in DA was 10% 1 year postoperatively and remained stable during the follow-up period, which showed no significant difference. The endoscopic findings showed the ratio of residual food in DA was lower than that in RY (DA:RY = 13.3%:13.6% and 8.4%:33.3% at 1 and 3 years postoperatively, respectively). Severe gastritis was extremely rare in DA (6.7% at 1 year and 15.6% at 3 years postoperatively). Bile reflux was more often found in DA than RY (DA:RY = 19.9%:4.8% and 26.6%:0% at 1 and 3 years postoperatively, respectively). Reflux esophagitis was found 10% of DA only. CONCLUSIONS Functional outcomes of the standardized DA were satisfactory and feasible. Our intracorporeal Billroth-I reconstruction, by resecting two-thirds of the stomach, can be one of the standard reconstruction methods after a laparoscopic distal gastrectomy.
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Affiliation(s)
- Masazumi Sakaguchi
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.
| | - Hisahiro Hosogi
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
| | - Yukinari Tokoro
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
| | - Daisuke Yagi
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
| | - Norihiro Shimoike
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.,Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shin Akagawa
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan.,Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | - Seiichiro Kanaya
- Department of Surgery, Osaka Red Cross Hospital, 5-30 Fudegasakicho, Tennoji Ward, Osaka, Osaka, 543-8555, Japan
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13
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Kimura Y, Mikami J, Yamasaki M, Hirao M, Imamura H, Fujita J, Takeno A, Matsuyama J, Kishi K, Hirao T, Fukunaga H, Demura K, Kurokawa Y, Takiguchi S, Eguchi H, Doki Y. Comparison of 5-year postoperative outcomes after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: Results from a multi-institutional randomized controlled trial. Ann Gastroenterol Surg 2021; 5:93-101. [PMID: 33532685 PMCID: PMC7832962 DOI: 10.1002/ags3.12400] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/15/2020] [Accepted: 08/24/2020] [Indexed: 12/29/2022] Open
Abstract
AIM We previously reported in a randomized controlled trial that Billroth I and Roux-en-Y reconstructions were generally equivalent regarding body weight change and nutritional status 1 year after distal gastrectomy for gastric cancer. We describe the long-term follow-up data 5 years after distal gastrectomy. METHODS We analyzed consecutive gastric cancer patients who were randomly assigned to undergo Billroth I or Roux-en-Y reconstruction after distal gastrectomy. We evaluated body weight change, nutritional status, late complications, quality of life (QOL) using the European Organization for Research and Treatment of Cancer Core QOL Questionnaire, and dysfunction using the Dysfunction After Upper Gastrointestinal Surgery for Cancer, 5 years after surgery. RESULTS A total of 228 patients (Billroth I = 105; Roux-en-Y = 123) were eligible for efficacy analyses in this study. Body weight loss 5 years after surgery did not differ significantly between the Billroth I and Roux-en-Y groups (10.0% ± 7.9% and 9.6% ± 8.4%, respectively; P = .70). There were no significant differences in other aspects of nutritional status between the two groups. Reflux esophagitis occurred in 19.0% of the patients in the Billroth I group vs 4.9% in the Roux-en-Y group (P = .002). Regarding QOL, Billroth I was significantly inferior to Roux-en-Y on the diarrhea scale (Billroth I: 28.6, Roux-en-Y: 16.0; P = .047). Regarding dysfunction, no score differed significantly between the two groups. CONCLUSIONS Billroth I and Roux-en-Y reconstructions were generally equivalent regarding body weight change, nutritional status, and QOL 5 years after distal gastrectomy, although Roux-en-Y more effectively prevented reflux esophagitis and diarrhea.
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Affiliation(s)
- Yutaka Kimura
- Department of SurgeryFaculty of MedicineKindai UniversityOsaka‐SayamaJapan
| | - Jota Mikami
- Department of SurgeryHyogo Prefectural Nishinomiya HospitalNishinomiyaJapan
| | - Makoto Yamasaki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
| | - Motohiro Hirao
- Department of SurgeryNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Hiroshi Imamura
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Junya Fujita
- Department of SurgerySakai City Medical CenterSakaiJapan
| | - Atsushi Takeno
- Department of SurgeryKansai Rosai HospitalAmagasakiJapan
| | - Jin Matsuyama
- Department of Gastroenterological SurgeryHigashiosaka City Medical CenterHigashiosakaJapan
| | - Kentaro Kishi
- Department of SurgeryOsaka Police HospitalOsakaJapan
| | | | | | | | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
| | - Shuji Takiguchi
- Department of Gastroenterological SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Hidetoshi Eguchi
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
| | - Yuichiro Doki
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
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Delta-shaped gastroduodenostomy after totally laparoscopic distal gastrectomy for gastric cancer: comparative study of original and modified methods. Surg Endosc 2020; 35:4167-4174. [PMID: 32780239 DOI: 10.1007/s00464-020-07896-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Delta-shaped anastomosis (DA) has been widely accepted as a standard procedure for intracorporeal Billroth-I reconstruction after laparoscopic distal gastrectomy. We introduced DA in 2010 at our hospital and later developed a modified DA method in which a stapled corner of the duodenal stump was removed simultaneously with closure of an entry hole to reduce postoperative complications. METHODS The clinical data of 507 patients undergoing laparoscopic distal gastrectomy with DA from October 2010 through December 2018 were retrospectively collected from our in-house database. On the basis of the reviewed data, patients were divided into two groups: the original DA group (org-DA, n = 392) and the modified DA group (mod-DA, n = 115). Surgical outcomes, postoperative nutritional parameters, and endoscopic findings 1 year after surgery were compared between the two groups. RESULTS Baseline characteristics were similar between the two groups. Anastomotic stricture occurred in three patients (0.8%) in the org-DA group and one patient (0.9%) in the mod-DA group (P = 0.911). Anastomotic leakage was recorded in five patients (1.3%) in the org-DA group and none of the patients (0%) in the mod-DA group (P = 0.593). One year after surgery, the change in body weight in the org-DA group/mod-DA group was - 8.1%/- 7.0% (P = 0.285), and the change in hemoglobin level was - 5.0%/- 3.9% (P = 0.012). Endoscopic examination at the 1-year follow-up in the mod-DA group showed smaller amounts of food residue (P = 0.008) as well as less residual gastritis (P < 0.001) than in the org-DA group. CONCLUSIONS The modified DA method can be performed safely with a complication rate comparable with the original DA method. Furthermore, better postoperative function is expected because of its more natural anatomy and physiology resulting from the modified method.
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15
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Gu L, Zhang K, Shen Z, Wang X, Zhu H, Pan J, Zhong X, Khadaroo PA, Chen P. Risk Factors for Duodenal Stump Leakage after Laparoscopic Gastrectomy for Gastric Cancer. J Gastric Cancer 2020; 20:81-94. [PMID: 32269847 PMCID: PMC7105415 DOI: 10.5230/jgc.2020.20.e4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/02/2020] [Accepted: 02/07/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose Duodenal stump leakage (DSL) is a potentially fatal complication that can occur after gastrectomy, but its underlying risk factors are unclear. This study aimed to investigate the risk factors and management of DSL after laparoscopic radical gastrectomy for gastric cancer (GC). Materials and Methods Relevant data were collected from several prospective databases to retrospectively analyze the data of GC patients who underwent Billroth II (B-II) or Roux-en-Y (R-Y) reconstruction after laparoscopic gastrectomy from 2 institutions (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences). The DSL risk factors were analyzed using univariate and multivariate analysis regression. Results A total of 810 patients were eligible for our analysis (426 with R-Y, 384 with B-II with Braun). Eleven patients had DSL (1.36%). Body mass index (BMI), elevated preoperative C-reactive protein (CRP) level, and unreinforced duodenal stump were the independent risk factors for DSL. DSL was diagnosed in 2–12 days, with a median of 8 days. Seven patients received conservative treatment, 3 patients received puncture treatment, and only 1 patient required reoperation. All patients recovered successfully after treatment. Conclusions The risk factors of DSL were BMI ≥24 kg/m2, elevated preoperative CRP level, and unreinforced duodenal stump. Nonsurgical treatments for DSL are preferred.
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Affiliation(s)
- Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
| | - Kang Zhang
- Department of Clinical Medicine, Medical College of Ningbo University, Ningbo, China
| | - Zefeng Shen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianfa Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hepan Zhu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Junhai Pan
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Zhong
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Parikshit Asutosh Khadaroo
- Department of Clinical Medicine, Monash University School of Medicine, Nursing and Health Sciences, Melbourne, Australia
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, China
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16
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Shen J, Ma X, Yang J, Zhang JP. Digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer. World J Gastrointest Oncol 2020; 12:21-36. [PMID: 31966911 PMCID: PMC6960078 DOI: 10.4251/wjgo.v12.i1.21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/09/2019] [Accepted: 11/04/2019] [Indexed: 02/05/2023] Open
Abstract
In addition to the popularity of laparoscopic gastrectomy (LG), many reconstructive procedures after LG have been reported. Surgical resection and lymphatic dissection determine long-term survival; however, the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer (GC). Presently, no consensus exists regarding the optimal reconstructive procedure. In this review, the current state of digestive tract reconstruction after LG is reviewed. According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction, we divide these reconstruction procedures into three categories consistent with the resection procedures. We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes (length of surgery and blood loss) and postoperative complications (anastomotic leakage and stricture) to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.
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Affiliation(s)
- Jian Shen
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Xiang Ma
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jing Yang
- Cardiovascular Center, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
| | - Jian-Ping Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
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17
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Du N, Chen M, Shen Z, Li S, Chen P, Khadaroo PA, Mao D, Gu L. Comparison of Quality of Life and Nutritional Status of Between Roux-en-Y and Billroth-I Reconstruction After Distal Gastrectomy: A Systematic Review and Meta-Analysis. Nutr Cancer 2019; 72:849-857. [PMID: 31460799 DOI: 10.1080/01635581.2019.1656262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: This paper purports to use a meta-analysis to compare the postoperative quality of life (QoL) and nutritional status of between Roux-en-Y (R-Y) and Billroth-I (B-I) reconstruction after distal gastrectomy.Methods: For this study, the following databases were searched for articles published from inception until December 2018: PubMed, Web of Science, EBSCO, and Cochrane library.Results: A total of 13 eligible studies, covering 3645 patients, were selected for a meta-analysis. The analysis showed that compared with B-I group in term of short-term outcomes, patients undergoing R-Y reconstruction did not only have significantly better physiological function (P = 0.02), but had significantly less pain (P = 0.04). In the long-term outcomes, the dyspnea and constipation in the B-I group were worse than that in the R-Y group (P = 0.004; P = 0.04, respectively). Patients in the B-I group had higher cholesterol than those in the R-Y group at 5 years postoperatively (P = 0.003). There were no significant differences in termof other nutritional indicators including total protein, cholesterol, albumin, hemoglobin and weight in short-term outcomes.Conclusions: The final conclusion was that R-Y may be superior to the B-I reconstruction in some aspects of QoL. Besides, R-Y reconstruction could reduce the patient's cholesterol level for a long time. For the short-term outcomes, there were no significant differences in other common nutritional indicators.
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Affiliation(s)
- Nannan Du
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Manman Chen
- Affiliated Hospital of Medical School, Ningbo University and Ningbo City Third Hospital, Ningbo, Zhejiang, China
| | - Zefeng Shen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Shengnan Li
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ping Chen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Parishit A Khadaroo
- Monash University School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Danyi Mao
- Basic Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lihu Gu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
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18
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Mueller CL, Lisbona R, Sorial R, Siblini A, Ferri LE. Sentinel Lymph Node Sampling for Early Gastric Cancer-Preliminary Results of A North American Prospective Study. J Gastrointest Surg 2019; 23:1113-1121. [PMID: 30859424 DOI: 10.1007/s11605-018-04098-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/28/2018] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Although endoscopic resection for early gastric cancer is well established, anatomical resection with regional lymphadenectomy is recommended for lesions at high risk for occult lymph node metastasis (e.g., lymphovascular invasion, poor grade, and deep submucosal invasion). However, 75-95% high-risk early gastric cancer (HR-EGC) patients ultimately have node-negative disease and could potentially have undergone organ-sparing resection. Due to the inadequacy of standard modalities to reliably rule out nodal metastases in HR-EGC patients, sentinel lymph node (SLN) sampling was developed in Asia with promising results. However, the applicability of this technique in the West has been brought into question due to potential differences in tumor histology and body habitus. This prospective study aimed to test SLN sampling for North American EGC patients. METHODS All patients with biopsy-confirmed T0-2 N0-1 M0 gastric adenocarcinoma at the Montreal General Hospital-McGill University Health Centre were eligible for enrollment. Esophageal and GEJ cancers were excluded due to the high rate of intrathoracic lymph node involvement. Peritumoral submucosal injection with T99 radiocolloid was performed endoscopically 24-30 h prior to surgery. Methylene blue dye injection was performed after induction of anesthesia. SLN basins were identified as those having > 10% of baseline tumor radiation signal or blue color, or both. After basins were individually removed, standard laparoscopic anatomical resection was then performed with D2 lymphadenectomy. ( ClinicalTrials.gov identifier: NCT03049345). Data are presented as median (interquartile range). RESULTS From July 2016-April 2018, 253 patients with esophagogastric adenocarcinoma were evaluated. Of these, 10 met inclusion criteria (90% male, age 66(30) years). Subtotal gastrectomy was performed in nine patients (90%) and length of stay was 4 (2) days. At least one SLN basin was identified in nine cases (90%). The median #SLN basins identified was 2(2) with a median of 5(5) total SLNs retrieved per patient. In the one case for which no SLN basins were identified, only blue dye injection was used, whereas SLNs were identified in all cases using the dual tracer method. Final T-stage was pT1b/T2 in four (40%), pT1a in two (20%), and Tx in four (40%). Two patients (20%) had lymph node metastases on final pathological analysis, both of which were identified by SLN sampling (accuracy 100%; false negative rate 0%). No adverse events related to SLN retrieval were identified. CONCLUSIONS This study represents the first prospective feasibility evaluation of sentinel lymph node sampling for early gastric cancer in North America with promising preliminary results. The dual tracer method was superior to single agent blue dye in identifying sentinel nodal basins. Considerable further study is necessary to verify the safety and utility of SLN mapping in North American patients with early gastric adenocarcinoma.
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Affiliation(s)
- Carmen L Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, 1650 Cedar Avenue, Room L8-512, Montreal, QC, H3G 1A4, Canada. .,Steinberg-Berstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Montreal, Canada.
| | - Robert Lisbona
- Division of Nuclear Medicine, Department of Diagnostic Imaging, McGill University Health Centre McGill University, Montreal, Canada
| | - Rafik Sorial
- Steinberg-Berstein Centre for Minimally Invasive Surgery, Montreal General Hospital, Montreal, Canada
| | - Aya Siblini
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, 1650 Cedar Avenue, Room L8-512, Montreal, QC, H3G 1A4, Canada
| | - Lorenzo E Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, 1650 Cedar Avenue, Room L8-512, Montreal, QC, H3G 1A4, Canada
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