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Han Y, Guo J, Huang Y, Xu D. Clinical comparison of total gastrectomy with single-vessel transection Roux-en-Y reconstruction vs total gastrectomy with conventional Roux-en-Y reconstruction for proximal gastric cancer. J Gastrointest Surg 2024:S1091-255X(24)00538-9. [PMID: 39004213 DOI: 10.1016/j.gassur.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/17/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE This study aimed to investigate the clinical benefits of single-vessel transection Roux-en-Y (SR-Y) reconstruction after total gastrectomy. METHODS A total of 194 patients with proximal gastric cancer were prospectively recruited at Fudan University Shanghai Cancer Center between January 2021 and September 2022. This study included 97 patients who underwent conventional Roux-en-Y reconstruction and 97 patients who underwent SR-Y reconstruction. Clinicopathologic characteristics, surgical outcomes, and postoperative complications were compared between the conventional and single-vessel transection groups. RESULTS There were no significant differences in baseline characteristics between the 2 groups in terms of age (P = .882), gender (P = .595), body mass index (P = .683), tumor location (P = .568), TNM stage (P = .122), tumor size (P = .927), anemia (P = .756), neoadjuvant chemotherapy (P = .730), and surgical approach (P = .592). However, compared with the conventional group, the single-vessel transection group had a shorter operation time (162.5 ± 37.6 vs 178.5 ± 48.3 min, respectively; P = .011) and less intraoperative bleeding (167.2 ± 91.8 vs 207.8 ± 167.5 mL, respectively; P = .037) after complete reservation of the terminal jejunal vascular arches. Nevertheless, there were no significant differences in tensions in the jejunal mesentery, durations of peritoneal drainage, postoperative hospital stay durations, the number of lymph node dissections, and early complications between the 2 groups. CONCLUSION SR-Y reconstruction can simplify surgical procedures, reduce operating time, and minimize intraoperative bleeding without increasing tensions in the jejunal mesentery or short-term complications. It is feasible and safe and worth further promotion in clinical practice.
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Affiliation(s)
- Yang Han
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jing Guo
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yakai Huang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dazhi Xu
- Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Gong J, Liu X, Wang G, Li W, Luo G, Lin Y, Zhang B, Chen C. Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy. Asian J Surg 2023; 46:4196-4201. [PMID: 36456439 DOI: 10.1016/j.asjsur.2022.11.067] [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: 08/15/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
AIM An innovative method of digestive tract reconstruction following proximal gastrectomy, the uncut interposed jejunum pouch, esophagus and residual stomach double anastomosis(Uncut-D), was established in recent years. In order to fully clarify the superiority of the procedure, this study has conducted a systematic analysis and thorough discussion. METHODS 118 patients with adenocarcinoma of the esophagogastric junction who underwent proximal gastrectomy were enrolled in this study. According to the methods of digestive tract reconstruction, these patients were divided into three groups: Uncut-D(n = 43), esophagogastrostomy (EG, n = 36), jejunal interposition (JI, n = 39).The preoperative indicators, surgical complications and related indicators of postoperative quality of life were analyzed. RESULTS There were no significant differences in preoperative data among all groups (P > 0.05); The digestive tract reconstruction time in Uncut-D group was more than that in EG group, and less than that in JI group (P < 0.05). The incidence of esophageal anastomotic stenosis in Uncut-D group was significantly lower than that in EG group (P < 0.05); In Uncut-D group, the incidence of reflux esophagitis, postoperative nutrition index(PNI), weight recovery and Visick classification were significantly better than those in EG group (P < 0.05), furthermore, the incidence of delayed gastric emptying,PNI and weight recovery were better than those in JI group (P < 0.05). CONCLUSIONS The Uncut-D procedure gave full play to jejunal continuity and the advantages of pouch, and played a valuable role in gastric and cardiac replacement, which significantly reduced long-term complications, improved postoperative nutritional status of patients and long-term quality of life.
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Affiliation(s)
- JiaQing Gong
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China.
| | - Xia Liu
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - GuangLan Wang
- Department of Ultrasound,The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Wei Li
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - GuoDe Luo
- Department of General Surgery, The General Hospital of Western Theater Command, Chengdu, Sichuan Province, China
| | - Yan Lin
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - Bin Zhang
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
| | - ChuanDong Chen
- Department of General Surgery, Dujiangyan Shoujia Hospital, Chengdu, Sichuan Province, China
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Chen G, Wu J, Zhang H, Wen Y, Luo G, Chen Z, Zhou J, Cao Y. Addition of Jejunal Lateral Anastomosis is Not Necessary for Gastric-Jejunum Pouch Anastomosis following Distal Gastrectomy: A Propensity-Score Matching Analysis. J INVEST SURG 2022; 35:1263-1268. [PMID: 35236193 DOI: 10.1080/08941939.2022.2032489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To make a propensity-score matching analysis on the clinical application of gastric-jejunum pouch anastomosis (GJPA) and continuous jejunal pouch and residual stomach anastomosis combined with jejunal lateral anastomosis (Contin-L). METHODS The clinic data of 287 patients who received distal gastrectomy from January 2015 to January 2019 were collected retrospectively. The enrolled patients were divided into the GJPA group and the Contin-L group according to the reconstruction method used. Clinical data and operation complications were analyzed. RESULTS Compared with Contin-L group, the duration of digestive tract reconstruction in the GJPA group was shorter, and the overall cost in the GJPA group was lower. No obvious intergroup differences were found in other intraoperative data, early surgical outcomes, incidence rates of reflux gastritis, anastomotic ulcer, postoperative nutritional and hematological indicators. The postoperative subjective feelings in the GJPA group were similar with those in the Contin-L groups. CONCLUSION Addition of jejunal lateral anastomosis is not necessary for GJPA following distal gastrectomy.
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Affiliation(s)
- Guangyu Chen
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Wu
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Hengdi Zhang
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Yi Wen
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Guode Luo
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Zhenyu Chen
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Zhou
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
| | - Yongkuan Cao
- General Surgery Centre, The General Hospital of Western Theater Command, Chengdu, China
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Gong J, Wang B, Wang J, Li Y, Cao Y, Li W, Shang M, Huang L. Continuous Jejunal Pouch and Residual Stomach Anastomosis Combined with Jejunal Lateral Anastomosis: An Improved Method of Gastrointestinal Reconstruction following Distal Gastrectomy. J INVEST SURG 2020; 35:293-300. [PMID: 33342314 DOI: 10.1080/08941939.2020.1854397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM Currently, there is no optimal digestive tract reconstruction technique well recognized by scholars after distal gastrectomy. A new reconstruction method, which was modified from the classic Roux-en-Y procedure, the continuous jejunal pouch and residual stomach anastomosis combined with jejunal lateral anastomosis (Contin-L), was established. In order to fully clarify the superiority of this procedure, this study has conducted a systematic analysis and prepared a summary of the clinical data of patients who underwent distal gastrectomy for gastric cancer. METHODS From June 2013 to March 2016, we enrolled 198 patients with gastric cancer who underwent radical D2 distal gastrectomy. According to the reconstruction methods, these patients were divided into three groups: Contin-L (n = 74), Billroth II (n = 59), and Roux-en-Y (n = 65) groups. The operation time for reconstruction, complications, prognostic nutritional index (PNI), and the Visick grading were analyzed. RESULTS Regarding long-term complications, such as reflux gastritis, the Contin-L procedure showed significantly better results than Billroth II (p < 0.0001). Regarding the long-term postoperative nutritional status, such as the PNI and body weight recovery, the Contin-L procedure displayed significantly better results than Billroth II and Roux-en-Y (p < 0.05). Postoperative subjective feelings evaluated by Visick grading were significantly more improved in the Contin-L than in the Billroth II and Roux-en-Y groups (p ≤ 0.01). CONCLUSIONS The Contin-L procedure gave full play to the advantages of jejunal continuity, and pouch and lateral anastomoses, which significantly reduced short- and long-term complications, and improved the long-term patient quality of life following the surgical procedure.
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Affiliation(s)
- JiaQing Gong
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - Bin Wang
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - JunQing Wang
- Department of Radiology, The General Hospital of Western Theater Command, ChengDu, Sichuan Province, China
| | - YunMing Li
- Depaartment of Medical Management, The General Hospital of Western Theater Command, ChengDu, Sichuan Province, China
| | - YongKuan Cao
- Center of General Surgery, The General Hospital of Western Theater Command, ChengDu, Sichuan Province, China
| | - Wei Li
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - Min Shang
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
| | - Ling Huang
- Department of General Surgery, ChengDu XinHua Hospital, ChengDu, Sichuan Province, China
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Wang H, Hu X, Chen S, Xiang J, Yang Z, Zhou Z, Chen Y, Lin Y, Chen Y, Peng J. Functional jejunal interposition versus Roux-en-Y anastomosis after total gastrectomy for gastric cancer: A prospective randomized clinical trial. Surg Oncol 2020; 34:236-244. [PMID: 32891336 DOI: 10.1016/j.suronc.2020.04.023] [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: 08/28/2019] [Revised: 04/12/2020] [Accepted: 04/21/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Nutritional status and quality of life deteriorate significantly after total gastrectomy for patients with gastric cancer. The numerous types of reconstruction proposed by medical researchers around the world have limited effect. This prospective, randomized clinical trial compared functional jejunal interposition with Roux-en-Y anastomosis to identify the optimal reconstruction procedure. METHODS This was a multi-center, prospective, randomized control trial. The enrolled patients were randomly assigned into the functional jejunal interposition group and the Roux-en-Y group. All patients were followed up at regular intervals after surgery. The endpoints were postoperative nutritional status, quality of life, and long-term postoperative complications. RESULTS A total of 113 patients were enrolled from August 2012 to September 2017. Until March 2018, the median follow-up period was 18 months. At 12 months after surgery, food intake per meal (P = 0.021), Prognosis Nutritional Index (P = 0.015), weight loss (P = 0.019), and Gastrointestinal Symptom Rating Scale score (P = 0.015) of the functional jejunal interposition group were significantly worse than those of the Roux-en-Y group. There was no significant difference in operative time, intraoperative blood loss, perioperative complications, time of first flatus and defecation after surgery, postoperative plasma nutritional parameters, Visick score, Eastern Cooperative Group physical condition score, and survival rate. CONCLUSION For patients with long-term survival after total gastrectomy for gastric cancer, the Roux-en-Y anastomosis is a better choice compared with functional jejunal interposition.
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Affiliation(s)
- Huashe Wang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Xiansheng Hu
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Shi Chen
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Jun Xiang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Zuli Yang
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Zhiwei Zhou
- Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yingbo Chen
- Department of Gastropancreatic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Yijia Lin
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Yonghe Chen
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China
| | - Junsheng Peng
- Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.
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Pouch Versus No Pouch Following Total Gastrectomy: Meta-analysis of Randomized and Non-randomized Studies. Ann Surg 2019; 269:1041-1053. [DOI: 10.1097/sla.0000000000003082] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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