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Junttila A, Helminen O, Helmiö M, Huhta H, Jalkanen A, Kallio R, Koivukangas V, Kokkola A, Laine S, Lietzen E, Louhimo J, Meriläinen S, Pohjanen VM, Rantanen T, Ristimäki A, Räsänen JV, Saarnio J, Sihvo E, Toikkanen V, Tyrväinen T, Valtola A, Kauppila JH. Comparison of Postoperative Complications After Gastrectomy for Gastric Cancer with Antecolic Versus Retrocolic Reconstruction: A Population-Based Study. Ann Surg Oncol 2024; 31:5263-5272. [PMID: 38750189 PMCID: PMC11236863 DOI: 10.1245/s10434-024-15415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/23/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND The purpose of this study was to examine the rates of 90-day anastomotic complications and other postoperative complications after total or partial gastrectomy with antecolic versus retrocolic reconstruction in a population-based setting. METHODS This population-based nationwide retrospective cohort study included all patients undergoing total or partial gastrectomy for gastric adenocarcinoma in Finland in 2005-2016, with follow-up until 31 December 2019. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs) of 90-day mortality. Results were adjusted for age, sex, year of the surgery, comorbidities, tumor locations, pathological stage, and neoadjuvant therapy. RESULTS A total of 2063 patients having gastrectomy with antecolic (n = 814) or retrocolic (n = 1249) reconstruction were identified from the registries. The anastomotic complication rate was 3.8% with antecolic reconstruction and 5.0% with retrocolic reconstruction. Antecolic reconstruction was not associated with a higher risk of anastomotic complications compared with retrocolic reconstruction in the adjusted analysis (OR 0.69, 95% CI 0.44-1.09) of the whole cohort or in the predefined subgroups. The reoperation rate was 8.2% with antecolic reconstruction and 7.7% with retrocolic reconstruction, without statistical significance. In subgroup analysis of total gastrectomy patients, the risk of major complications was lower with antecolic reconstruction compared with retrocolic reconstruction (OR 0.62, 95% CI 0.45-0.86). CONCLUSIONS The rate of anastomotic complications did not differ after antecolic versus retrocolic reconstruction after total or partial gastrectomy. In total gastrectomies, the risk of major complications was lower after antecolic compared with retrocolic reconstruction.
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Affiliation(s)
- Anna Junttila
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.
| | - Olli Helminen
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mika Helmiö
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Heikki Huhta
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Aapo Jalkanen
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Raija Kallio
- Department of Oncology and Haematology, Oulu University Hospital, Oulu, Finland
| | - Vesa Koivukangas
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Arto Kokkola
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Simo Laine
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Elina Lietzen
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Johanna Louhimo
- Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanna Meriläinen
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Vesa-Matti Pohjanen
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomo Rantanen
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Ari Ristimäki
- Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jari V Räsänen
- Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juha Saarnio
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Eero Sihvo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Vesa Toikkanen
- Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Tuula Tyrväinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - Antti Valtola
- Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Joonas H Kauppila
- Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Luo W, Li F, Qian C, Lu T, Xiao Y, Xu Z, Jia Y. A novel technique for NO.253 lymph node dissection and left colic artery preservation to avoid potential postoperative internal hernia in laparoscopic radical resection for rectal cancer. BMC Surg 2024; 24:202. [PMID: 38965517 PMCID: PMC11223325 DOI: 10.1186/s12893-024-02492-2] [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: 11/23/2023] [Accepted: 06/25/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND The preservation of the left colic artery (LCA) has emerged as a preferred approach in laparoscopic radical resection for rectal cancer. However, preserving the LCA while simultaneously dissecting the NO.253 lymph node can create a mesenteric defect between the inferior mesenteric artery (IMA), the LCA, and the inferior mesenteric vein (IMV). This defect could act as a potential "hernia ring," increasing the risk of developing an internal hernia after surgery. The objective of this study was to introduce a novel technique designed to mitigate the risk of internal hernia by filling mesenteric defects with autologous tissue. METHODS This new technique was performed on eighteen patients with rectal cancer between January 2022 and June 2022. First of all, dissected the lymphatic fatty tissue on the main trunk of IMA from its origin until the LCA and sigmoid artery (SA) or superior rectal artery (SRA) were exposed and then NO.253 lymph node was dissected between the IMA, LCA and IMV. Next, the SRA or SRA and IMV were sequentially ligated and cut off at an appropriate location away from the "hernia ring" to preserve the connective tissue between the "hernia ring" and retroperitoneum. Finally, after mobilization of distal sigmoid, on the lateral side of IMV, the descending colon was mobilized cephalad. Patients'preoperative baseline characteristics and intraoperative, postoperative complications were examined. RESULTS All patients' potential "hernia rings" were closed successfully with our new technique. The median operative time was 195 min, and the median intraoperative blood loss was 55 ml (interquartile range 30-90). The total harvested lymph nodes was 13.0(range12-19). The median times to first flatus and liquid diet intake were both 3.0 days. The median number of postoperative hospital days was 8.0 days. One patient had an injury to marginal arterial arch, and after mobolization of splenic region, tension-free anastomosis was achieved. No other severe postoperative complications such as abdominal infection, anastomotic leakage, or bleeding were observed. CONCLUSIONS This technique is both safe and effective for filling the mesenteric defect, potentially reducing the risk of internal hernia following laparoscopic NO.253 lymph node dissection and preservation of the left colic artery in rectal cancer surgeries.
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Affiliation(s)
- Wenjun Luo
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China.
| | - Fugen Li
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Chuan Qian
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Tingting Lu
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Yanling Xiao
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Zhengwen Xu
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
| | - Yingdong Jia
- Department of Gastrointestinal Surgery, Suining Central Hospital, Suining, Sichuan, China
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3
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Serizawa A, Shibasaki S, Nakauchi M, Suzuki K, Akimoto S, Tanaka T, Inaba K, Uyama I, Suda K. Standardized procedure for preventing late intestinal complications following minimally invasive total gastrectomy for gastric cancer: a single-center retrospective cohort study. Surg Endosc 2024; 38:4067-4084. [PMID: 38834724 DOI: 10.1007/s00464-024-10929-1] [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: 11/24/2023] [Accepted: 05/15/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Although minimally invasive total gastrectomy for gastric cancer is commonly performed, reports regarding late complications are limited. We have made several improvements each time we experienced severe late complications since 2009. This study aimed to evaluate the clinical efficacy of these improved procedures in preventing late complications. METHODS Between January 2009 and December 2019, 302 patients who underwent laparoscopic or robotic total gastrectomy for gastric cancer were enrolled. The patients were divided into two groups: Period-I (2009-2013, before established standardization of procedure, 166 patients) and Period-II (2014-2019, after established standardization of procedure, 136 patients). The standardized procedure comprised four major steps, including closure of the mesentery defects and diaphragm crus, circumferential fixation of the anastomotic site into the diaphragm, and linearization around the anastomotic site of esophagojejunostomy. The incidence of late complications was retrospectively compared between the two groups. RESULTS Late overall complications that occurred over 30 days after surgery were observed in 19 (6.3%) patients. In all, 14 of 24 (58.3%) patients admitted due to late intestinal complications eventually required reoperation for treatment. The most frequent complication was nonstenotic outlet obstruction of the distal jejunal limb. The incidence of late overall complications was significantly lower in Period-II than in Period-I (2.9 vs 9.0%, p = 0.030). Intestinal complications were reduced considerably in Period-II. The 3-year cumulative incidence rate of late overall complications was significantly lower in Period-II than in Period-I (0.03 vs 0.10, p = 0.035). Period-I as the only independent risk factor for the development of late intestinal complications. CONCLUSION Late complications after laparoscopic total gastrectomy sometimes occurred, and more than half of the patients with intestinal complications required reoperation. Our standardized procedure was associated with a lower risk of late intestinal complications after minimally invasive total gastrectomy followed by intracorporeal esophagojejunostomy using linear staplers in a cohort of patients with gastric cancer.
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Affiliation(s)
- Akiko Serizawa
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Susumu Shibasaki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Masaya Nakauchi
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazumitsu Suzuki
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Shingo Akimoto
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Tsuyoshi Tanaka
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
- Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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4
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Honda M, Ri M, Kinoshita T, Kawakubo H, Aizawa M, Bamba T, Matsuda S, Kawamura H, Yoshida M, Nunobe S. Comparison of the survival outcomes between retrocolic and antecolic Roux-en-Y reconstruction after gastrectomy for gastric cancer. Ann Gastroenterol Surg 2024; 8:443-449. [PMID: 38707226 PMCID: PMC11066478 DOI: 10.1002/ags3.12779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/27/2023] [Accepted: 01/16/2024] [Indexed: 05/07/2024] Open
Abstract
Background There are two methods of Roux-en-Y (RY) reconstruction after gastrectomy: the antecolic route (ACR) and retrocolic route (RCR). There is no evidence to support that the ACR achieves comparable long-term survival. Methods This was a multi-center historical cohort study. Patients diagnosed with clinical T3/4a and any N stage who underwent open gastrectomy and R0 resection for gastric adenocarcinoma between January 2006 and December 2012 were enrolled. The primary outcome was the hazard ratio of ACR for overall survival, with adjustment for confounding factors by propensity score matching, and a Cox proportional hazards model. Results A total of 1758 eligible patients were identified from the database. After matching, 410 patients in the ACR and RCR groups were included in the final analysis. The adjusted hazard ratio (95% CI) for ACR was 1.148 (0.870-1.492). The five-year survival rates in the ACR and RCR groups were 74.3% (69.5-78.4) and 77.3% (72.3-81.2), respectively. The short-term surgical outcomes of the two groups did not differ to a statistically significant extent. Conclusion The route used to lift the jejunum in RY reconstruction did not affect the incidence of long-term survival or postoperative complications. The ACR and RCR are both acceptable options for RY reconstruction during gastric cancer surgery.
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Affiliation(s)
- Michitaka Honda
- Department of SurgerySouthern Tohoku General HospitalKoriyamaJapan
- Department of Minimally Invasive Surgical and Medical OncologyFukushima Medical UniversityFukushimaJapan
| | - Motonari Ri
- Department of Gastroenterological SurgeryCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
| | - Takahiro Kinoshita
- Department of Gastric SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | | | - Masaki Aizawa
- Department of Digestive SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Takeo Bamba
- Department of Digestive SurgeryNiigata Cancer Center HospitalNiigataJapan
| | - Satoru Matsuda
- Department of SurgeryKeio University School of MedicineTokyoJapan
| | - Hidetaka Kawamura
- Department of SurgerySouthern Tohoku General HospitalKoriyamaJapan
- Department of Minimally Invasive Surgical and Medical OncologyFukushima Medical UniversityFukushimaJapan
| | - Mitsumasa Yoshida
- Department of Gastric SurgeryNational Cancer Center Hospital EastKashiwaJapan
| | - Souya Nunobe
- Department of Gastroenterological SurgeryCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
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5
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Wu QL, Liu QZ, Xi YY, Deng XQ, Xu TS, Xie ZC, Chen JA, Yuan Y. Closed or Unclosed Mesentery? A Meta-analysis of Internal Herniation After Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2023:10.1007/s11695-023-06594-3. [PMID: 37081253 DOI: 10.1007/s11695-023-06594-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
During the laparoscopic Roux-en-Y gastric bypass procedure, closing mesentery or not was still controversial according to preexisted studies. So, the current meta-analysis aimed to compare the outcome of closure versus non-closure of mesenteric defects in laparoscopic Roux-en-Y gastric bypass. Fifteen studies were included, enrolling 53,488 patients. Based on the outcome of analysis, regarding internal hernia, Petersen space's IH, jejunal mesenteric's IH, hospital days, and reoperation, closure of the mesentery was better than non-closure. Besides, small bowel obstruction, anastomosis ulcer, stenosis, leakage, bleeding, gastrointestinal perforation, and postoperative BMI of patients show no difference between non-closure and closure.
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Affiliation(s)
- Qian-Long Wu
- Guangzhou Medical University, Guangzhou, 510180, China.
| | - Quan-Zhen Liu
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Ying-Yun Xi
- Guangzhou Medical University, Guangzhou, 510180, China
| | | | - Tong-Shan Xu
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Zi-Chun Xie
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Jin-An Chen
- Guangzhou Medical University, Guangzhou, 510180, China
| | - Yi Yuan
- Guangzhou Medical University, Guangzhou, 510180, China
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6
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Aoyama R, Tsunoda S, Okamura R, Yamashita Y, Hata H, Kinjo Y, Miki A, Kanaya S, Yamamoto M, Matsuo K, Manaka D, Tanaka E, Kawada H, Kondo M, Itami A, Kan T, Kadokawa Y, Ito T, Hirai K, Hosogi H, Nishigori T, Hisamori S, Hoshino N, Hida K, Goto Y, Nakayama T, Obama K. Comparison of Minimally Invasive Surgery with Open Surgery for Remnant Gastric Cancer: A Multi-institutional Cohort Study. Ann Surg Oncol 2023; 30:3605-3614. [PMID: 36808589 DOI: 10.1245/s10434-023-13232-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/24/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Despite growing evidence of the effectiveness of minimally invasive surgery (MIS) for primary gastric cancer, MIS for remnant gastric cancer (RGC) remains controversial due to the rarity of the disease. This study aimed to evaluate the surgical and oncological outcomes of MIS for radical resection of RGC. PATIENTS AND METHODS Patients with RGC who underwent surgery between 2005 and 2020 at 17 institutions were included, and a propensity score matching analysis was performed to compare the short- and long-term outcomes of MIS with open surgery. RESULTS A total of 327 patients were included in this study and 186 patients were analyzed after matching. The risk ratios for overall and severe complications were 0.76 [95% confidence interval (CI): 0.45, 1.27] and 0.65 (95% CI: 0.32, 1.29), respectively. The MIS group had significantly less blood loss [mean difference (MD), -409 mL; 95% CI: -538, -281] and a shorter hospital stay (MD, -6.5 days; 95% CI: -13.1, 0.1) than the open surgery group. The median follow-up duration of this cohort was 4.6 years, and the 3-year overall survival were 77.9% and 76.2% in the MIS and open surgery groups, respectively [hazard ratio (HR), 0.78; 95% CI: 0.45, 1.36]. The 3-year relapse-free survival were 71.9% and 62.2% in the MIS and open surgery groups, respectively (HR, 0.71; 95% CI: 0.44, 1.16). CONCLUSIONS MIS for RGC showed favorable short- and long-term outcomes compared to open surgery. MIS is a promising option for radical surgery for RGC.
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Affiliation(s)
- Ryuhei Aoyama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. .,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.
| | - Ryosuke Okamura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Yoshito Yamashita
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hiroaki Hata
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Yosuke Kinjo
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Gastroenterological Surgery and Oncology, Himeji Medical Center, Himeji, Japan
| | - Akira Miki
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Toyooka Hospital, Toyooka, Japan
| | - Seiichiro Kanaya
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Michihiro Yamamoto
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Shiga General Hospital, Moriyama, Japan
| | - Koichi Matsuo
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Dai Manaka
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Eiji Tanaka
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Kitano Hospital, Osaka, Japan
| | - Hironori Kawada
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masato Kondo
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Itami
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Takatsugu Kan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Yoshio Kadokawa
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan
| | - Tetsuo Ito
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Kenjiro Hirai
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Otsu City Hospital, Otsu, Japan
| | - Hisahiro Hosogi
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan.,Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshihito Goto
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
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7
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Apostolou KG, Lazaridis II, Kanavidis P, Triantafyllou M, Gkiala A, Alexandrou A, Ntourakis D, Delko T, Schizas D. Incidence and risk factors of symptomatic Petersen's hernias in bariatric and upper gastrointestinal surgery: a systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:49. [PMID: 36662172 DOI: 10.1007/s00423-023-02798-4] [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: 09/19/2022] [Accepted: 11/29/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study was to investigate the actual incidence of symptomatic Petersen's hernias (PH) as well as identify risk factors for their occurrence. METHODS Search was performed in Medline (via PubMed), Web of Science, and Cochrane library, using the keywords "Petersen Or Petersen's AND hernia" and "Internal hernia." Only studies of symptomatic PH were eligible. Fifty-three studies matched our criteria and were included. Risk of bias for each study was independently assessed using the checklist modification by Hoy et al. Analysis was performed using random-effects models, with subsequent subgroup analyses. RESULTS A total of 81,701 patients were included. Mean time interval from index operation to PH diagnosis was 17.8 months. Total small bowel obstruction (SBO) events at Petersen's site were 737 (0.7%). SBO incidence was significantly higher in patients without defect closure (1.2% vs 0.3%, p < 0.01), but was not significantly affected by anastomosis fashion (retrocolic 0.7% vs antecolic 0.8%, p = 0.99). SBO incidence was also not significantly affected by the surgical approach (laparoscopic = 0.7% vs open = 0.1%, p = 0.18). However, retrocolic anastomosis was found to be associated with marginally, but not significantly, increased SBO rate in patients with Petersen's space closure, compared with the antecolic anastomosis (p = 0.09). CONCLUSION PH development may occur after any gastric operation with gastrojejunal anastomosis. Contrary to anastomosis fashion and surgical approach, defect closure was demonstrated to significantly reduce SBO incidence. Limitations of this study may include the high heterogeneity and the possible publication bias across the included studies.
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Affiliation(s)
- Konstantinos G Apostolou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece.
| | - Ioannis I Lazaridis
- Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | - Prodromos Kanavidis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Margarita Triantafyllou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Anastasia Gkiala
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | - Andreas Alexandrou
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
| | | | - Tarik Delko
- Chirurgie Zentrum St. Anna, St. Anna-Strasse 32, 6006, Lucerne, Switzerland
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 17 Agiou Thoma Str, 11527, Athens, Greece
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8
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Angehrn FV, Neuschütz KJ, Fourie L, Becker P, von Flüe M, Steinemann DC, Bolli M. Continuously sutured versus linear-stapled anastomosis in robot-assisted hybrid Ivor Lewis esophageal surgery following neoadjuvant chemoradiotherapy: a single-center cohort study. Surg Endosc 2022; 36:9435-9443. [PMID: 35854126 PMCID: PMC9652283 DOI: 10.1007/s00464-022-09415-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/24/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Esophageal cancer surgery is technically highly demanding. During the past decade robot-assisted surgery has successfully been introduced in esophageal cancer treatment. Various techniques are being evaluated in different centers. In particular, advantages and disadvantages of continuously sutured (COSU) or linear-stapled (LIST) gastroesophageal anastomoses are debated. Here, we comparatively analyzed perioperative morbidities and short-term outcomes in patients undergoing hybrid robot-assisted esophageal surgery following neoadjuvant chemoradiotherapy (nCRT), with COSU or LIST anastomoses in a single center. METHODS Following standardized, effective, nCRT, 53 patients underwent a hybrid Ivor Lewis robot-assisted esophagectomy with COSU (n = 32) or LIST (n = 21) gastroesophageal anastomoses. Study endpoints were intra- and postoperative complications, in-hospital morbidity and mortality. Duration of operation, intensive care unit (ICU) and overall hospital stay were also evaluated. Furthermore, rates of rehospitalization, endoscopies, anastomotic stenosis and recurrence were assessed in a 90-day follow-up. RESULTS Demographics, ASA scores and tumor characteristics were comparable in the two groups. Median duration of operation was similar in patients with COSU and LIST anastomosis (467 vs. 453 min, IQR 420-521 vs. 416-469, p = 0.0611). Major complications were observed in 4/32 (12.5%) and 4/21 (19%) patients with COSU or LIST anastomosis, respectively (p = 0.697). Anastomotic leakage was observed in 3/32 (9.3%) and 2/21 (9.5%) (p = 1.0) patients with COSU or LIST anastomosis, respectively. Pleural empyema occurred in 1/32 (3.1%) and 2/21 (9.5%) (p = 0.555) patients, respectively. Mortality was similar in the two groups (1/32, 3.1% and 1/21, 4.7%, p = 1.0). Median ICU stay did not differ in patients with COSU or LIST anastomosis (p = 0.255), whereas a slightly, but significantly (p = 0.0393) shorter overall hospital stay was observed for COSU, as compared to LIST cohort (median: 20 vs. 21 days, IQR 17-22 vs. 18-28). CONCLUSIONS COSU is not inferior to LIST in the performance of gastroesophageal anastomosis in hybrid Ivor Lewis operations following nCRT.
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Affiliation(s)
- Fiorenzo V Angehrn
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland.
- Department of Surgery, University Hospital Basel, Spitalstrasse 23, 4031, Basel, Switzerland.
| | - Kerstin J Neuschütz
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Lana Fourie
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Pauline Becker
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Markus von Flüe
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Daniel C Steinemann
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
| | - Martin Bolli
- Department of Surgery, Clarunis AG - University Center for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland
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