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Zhong Q, Wu D, Jiang YM, He QL, Dang XY, Xu DB, Sun YQ, Su GQ, Guo KQ, Cai LS, Zhang HX, Ye W, Lin GT, Li P, Xie JW, Chen QY, Zheng CH, Lu J, Huang CM, Lin JX. The safety, feasibility, and oncological outcomes of laparoscopic completion total gastrectomy for remnant gastric cancer: a prospective study with 3-year follow-up (FUGES-004 study). Int J Surg 2024; 110:3382-3391. [PMID: 38597388 PMCID: PMC11175827 DOI: 10.1097/js9.0000000000001388] [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: 11/10/2023] [Accepted: 03/11/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The efficacy of laparoscopic completion total gastrectomy (LCTG) for remnant gastric cancer (RGC) remains controversial. METHODS The primary outcome was postoperative morbidity within 30 days after surgery. Secondary outcomes included 3-year disease-free survival (DFS), 3-year overall survival (OS), and recurrence. Inverse probability treatment weighted (IPTW) was used to balance the baseline between LCTG and OCTG. RESULTS Final analysis included 46 patients with RGC who underwent LCTG at the FJMUUH between June 2016 and June 2020. The historical control group comprised of 160 patients who underwent open completion total gastrectomy (OCTG) in the six tertiary teaching hospitals from CRGC-01 study. After IPTW, no significant difference was observed between the LCTG and OCTG groups in terms of incidence (LCTG vs. OCTG: 28.0 vs. 35.0%, P =0.379) or severity of complications within 30 days after surgery. Compared with OCTG, LCTG resulted in better short-term outcomes and faster postoperative recovery. However, the textbook outcome rate was comparable between the two groups (45.9 vs. 32.8%, P =0.107). Additionally, the 3-year DFS and 3-year OS of LCTG were comparable to those of OCTG (DFS: log-rank P =0.173; OS: log-rank P =0.319). No significant differences in recurrence type, mean recurrence time, or 3-year cumulative hazard of recurrence were observed between the two groups (all P >0.05). Subgroup analyses and concurrent comparisons demonstrated similar trends. CONCLUSIONS This prospective study suggested that LCTG was noninferior to OCTG in both short-term and long-term outcomes. In experienced centers, LCTG may be considered as a viable treatment option for RGC.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Dong Wu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Yi-ming Jiang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Qing-Liang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University
| | - Xue-Yi Dang
- Department of General Surgery, Shanxi Provincial Cancer Hospital, Shanxi Province
| | - Dong-Bo Xu
- Department of Gastrointestinal Surgery, Longyan First Hospital Affiliated to Fujian Medical University
| | - Yu-Qin Sun
- Department of General Surgery Unit 4, ZhangZhou Affiliated Hospital of Fujian Medical University, Zhangzhou
| | - Guo-Qiang Su
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian Province, People’s Republic of China
| | - Kai-Qing Guo
- Department of General Surgery, Shanxi Provincial Cancer Hospital, Shanxi Province
| | - Li-Sheng Cai
- Department of General Surgery Unit 4, ZhangZhou Affiliated Hospital of Fujian Medical University, Zhangzhou
| | - Hao-xiang Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Wen Ye
- Department of Gastrointestinal Surgery, Longyan First Hospital Affiliated to Fujian Medical University
| | - Guang-tan Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital
- Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University
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Li ZW, Qiu YY, Liu F, Liu XR, Zhang W, Peng D. The Effect of Surgical Approach on Clinical Outcomes in 535 Patients with Remnant Gastric Cancer. J Laparoendosc Adv Surg Tech A 2023; 33:915-922. [PMID: 37477897 DOI: 10.1089/lap.2023.0164] [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] [Indexed: 07/22/2023] Open
Abstract
Purpose: This study aimed to evaluate the effect of laparoscopic gastrectomy (LG) and open gastrectomy (OG) on clinical outcomes in patients with remnant gastric cancer (RGC). Materials and Methods: The databases of PubMed, EMBASE, and Cochrane Library were used to search for eligible studies from inception to April 1st, 2023. Hazard ratios (HRs), mean difference (MD), odds ratios (OR), and 95% confidence intervals (CIs) were pooled up to analyze. The Newcastle-Ottawa Scale (NOS) scores were used to evaluate the quality of the included studies. This study was performed with RevMan 5.3 (The Cochrane Collaboration, London, United Kingdom) software. Results: A total of 11 studies involving 535 RGC patients were included in this study. In terms of basic information, we found that the OG group had a higher American Society of Anesthesiologists (ASA) grade (≥2) (OR = 0.24, I2 = 54%, 95% CI = 0.08-0.71, P = .01) than the LG group. In terms of postoperative outcomes, we found that the LG group had longer operative time (MD = 33.95, I2 = 58%, 95% CI = 15.05-52.85, P < .01), shorter postoperative hospital stay (MD = 5.08, I2 = 84%, 95% CI = -9.74 to -0.42, P = .03), shorter length of incision (MD = -7.15, I2 = 94%, 95% CI = -10.99 to -3.31, P < .01), earlier food intake (MD = -3.09, I2 = 76%, 95% CI = -4.84 to -1.35, P < .01), and earlier time to first flatus (MD = -0.84, I2 = 0%, 95% CI = -1.09 to -0.59, P < .01). We found that there was no statistically significant difference in overall survival (HR = 0.96, I2 = 0%, 95% CI = 0.48-1.93, P = .92) between the LG group and the OG group. Conclusion: LG for RGC patients had longer surgical time, shorter postoperative hospital stay, shorter length of incision, earlier food intake, and earlier time to first flatus.
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Affiliation(s)
- Zi-Wei Li
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Yu Qiu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Rui Liu
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Zhang
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Heng W, Lye JYT, Lee ZJ, Chan WH, Tan JTH. Laparoscopic completion gastrectomy: A single-institution case series and systematic review of the literature. Asian J Endosc Surg 2023; 16:731-740. [PMID: 37524315 DOI: 10.1111/ases.13235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/12/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Completion gastrectomy with lymphadenectomy for remnant gastric cancer (RGC) is currently the gold standard for patients with resectable disease. Multiple surgical approaches can be adopted; however, there exists no agreement on the best choice due to the low incidence of RGC. With its anticipated increase in prevalence, we thus sought to evaluate the feasibility and efficacy of the laparoscopic approach versus conventional laparotomy via a pooled analysis of existing literature. METHODS A retrospective review of five consecutive patients who underwent laparoscopic completion gastrectomy from August 2017 to June 2022 was performed following Institutional Review Board waiver. A comprehensive systematic review of literature on laparoscopic completion gastrectomy from the Pubmed, Embase, MEDLINE, Web of Science and Cochrane databases was conducted to supplement the experience from our institution. RESULTS Four patients had prior benign gastric disease and one had prior gastric cancer. Two patients experienced severe postoperative complications but there were otherwise no reports of conversion to laparotomy or mortality. Mean operative duration was 295 minutes. Mean duration to oral intake and discharge was 6.8 and 14.6 days respectively. Results from our pooled analysis of 591 cases suggested that the laparoscopic approach was associated with longer operative durations but delivered fewer postoperative complications, shorter duration to dietary resumption and shorter lengths of stay over conventional laparotomy. CONCLUSION Laparoscopic completion gastrectomy is indeed a more challenging procedure due to the presence of dense adhesions from previous surgery. However, the procedure can be performed safely with superior outcomes as compared to conventional laparotomy.
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Affiliation(s)
- Wei Heng
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Jian Ying Tiffany Lye
- Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Zhen Jin Lee
- Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Weng Hoong Chan
- Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Tian Hui Tan
- Department of Upper GI and Bariatric Surgery, Singapore General Hospital, Singapore, Singapore
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Wu D, Song QY, Li XG, Xie TY, Lu YX, Zhang BL, Li S, Wang XX. 3D laparoscopic-assisted vs open gastrectomy for carcinoma in the remnant stomach: A retrospective cohort study. World J Gastrointest Surg 2022; 14:754-764. [PMID: 36157370 PMCID: PMC9453325 DOI: 10.4240/wjgs.v14.i8.754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/02/2022] [Accepted: 07/31/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Three-dimensional (3D) laparoscopic technique has gradually been applied to the treatment of carcinoma in the remnant stomach (CRS), but its clinical efficacy remains controversial.
AIM To compare the short-term and long-term results of 3D laparoscopic-assisted gastrectomy (3DLAG) with open gastrectomy (OG) for CRS.
METHODS The clinical data of patients diagnosed with CRS and admitted to the First Medical Center of Chinese PLA General Hospital from January 2016 to January 2021 were retrospectively collected. A total of 84 patients who met the inclusion and exclusion criteria were enrolled. All their clinical data were collected and a database was established. All patients were treated with 3DLAG or OG by experienced surgeons and were divided into two groups based on the different surgical methods mentioned above. By using outpatient and telephone follow-up, we were able to determine postoperative survival and tumor status. The postoperative short-term efficacy and 1-year and 3-year overall survival (OS) rates were compared between the two groups.
RESULTS Among 84 patients with CRS, 48 were treated with OG and 36 with 3DLAG. All patients successfully completed surgery. There was no significant difference between the two groups in terms of age, gender, body mass index, ASA score, initial disease state (benign or malignant), primary surgical anastomosis method, interval time of carcinogenesis, and tumorigenesis site. Patients in the 3DLAG group experienced less intraoperative blood loss (188.33 ± 191.35 mL vs 305.83 ± 303.66 mL; P = 0.045) and smaller incision (10.86 ± 3.18 cm vs 20.06 ± 5.17 cm; P < 0.001) than those in the OG group. 3DLAGC was a more minimally invasive method. 3DLAGC retrieved significantly more lymph nodes than OG (14.0 ± 7.17 vs 10.73 ± 6.82; P = 0.036), whereas the number of positive lymph nodes did not differ between the two groups (1.56 ± 2.84 vs 2.35 ± 5.28; P = 0.413). The complication rate (8.3% vs 20.8%; P = 0.207) and intensive care unit admission rate (5.6% vs 14.5%; P = 0.372) were equivalent between the two groups. In terms of postoperative recovery, the 3DLAGC group had a lower visual analog score, shorter indwelling time of gastric and drainage tubes, shorter time of early off-bed motivation, shorter time of postoperative initial flatus and initial soft diet intake, shorter postoperative hospital stay and total hospital stay, and there were significant differences, showing better short-term efficacy. The 1-year and 3-year OS rates of OG group were 83.2% [95% confidence interval (CI): 72.4%-95.6%] and 73.3% (95%CI: 60.0%-89.5%) respectively. The 1-year and 3-year OS rates of the 3DLAG group were 87.3% (95%CI: 76.4%-99.8%) and 75.6% (95%CI: 59.0%-97.0%), respectively. However, the 1-year and 3-year OS rates were similar between the two groups, which suggested that long-term survival results were comparable between the two groups (P = 0.68).
CONCLUSION Compared with OG, 3DLAG for CRS achieved better short-term efficacy and equivalent oncological results without increasing clinical complications. 3DLAG for CRS can be promoted safely and effectively in selected patients.
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Affiliation(s)
- Di Wu
- Medical School of Chinese PLA, Beijing 100853, China
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Qi-Ying Song
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xiong-Guang Li
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Tian-Yu Xie
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi-Xun Lu
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Ben-Long Zhang
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Shuo Li
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing 100853, China
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Çiçek E, Zengin A, Güneş Ö, Sümer F, Kayaalp C. Laparoscopic gastrectomy in remnant gastric cancer. Turk J Surg 2021; 37:59-62. [PMID: 34585095 DOI: 10.47717/turkjsurg.2021.5123] [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: 01/13/2021] [Accepted: 01/31/2021] [Indexed: 12/13/2022]
Abstract
Objectives Remnant Gastric Cancer (RGC) describes cancers occurring in the remaining stomach and/or anastomosis in the follow-up after gastric cancer or benign gastric surgery. RGC is diagnosed in esophago-gastroscopy follow-ups of patients who underwent this surgery in the past. Again, the increase in the success of gastric cancer surgery and following medical treatments has increased the incidence of RGC in long-term follow-up after gastric cancer surgery. Laparoscopic surgery has been also reported in few cases. In the present study, the purpose was to present the results of the first five patients that underwent laparoscopic total gastrectomy due to RGC in our clinic. Material and Methods The patients who underwent laparoscopic gastric cancer surgery between November 2014 and December 2018 were evaluated retrospectively. Results Mean age of the patients was 62.4 years (ranging between 49 and 74 years). Two of these patients had a surgical history due to gastric cancer and 3 due to peptic ulcer. Surgery was completed laparoscopically in all patients. In the early period, one patient had to undergo re-surgery due to stenosis in Jejuno-Jejunostomy, and the patient died. One patient underwent laparotomy due to colonic stenosis in the second month after the surgery. Recurrence was detected on the 140th and 180th days of follow-up in the other two patients. Conclusion Laparoscopic surgery is a technically applicable method in RGC; however, it is also a risk factor for past surgical postoperative complications. Early recurrence in this group of patients requires a comparison of open and laparoscopic surgery.
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Affiliation(s)
- Egemen Çiçek
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Akile Zengin
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Örgün Güneş
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Fatih Sümer
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cüneyt Kayaalp
- Department of General Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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Sakamoto E, Dias AR, Ramos MFKP, Charruf AZ, Ribeiro-Junior U, Zilberstein B, Cecconello I. Laparoscopic Completion Total Gastrectomy for Remnant Gastric Cancer. J Laparoendosc Adv Surg Tech A 2021; 31:803-807. [PMID: 33232633 DOI: 10.1089/lap.2020.0569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Remnant gastric cancer (RGC) is increasing due to past use of subtotal gastrectomy to treat benign diseases, improvements in the detection of gastric cancer, and increased survival rates after gastrectomy for gastric cancer. Laparoscopic access provides the advantages and benefits of minimally invasive surgery. However, laparoscopic completion total gastrectomy (LCTG) for RGC is technically demanding, even for experienced surgeons. Because of its rarity and heterogeneity, no standard surgical strategy has been established and few surgeons will develop technical expertise to carry out this procedure. Aim: To describe our standard technique, giving surgeons a head start in LCTG and report the early experience with this stepwise approach. Materials and Methods: We detail all the steps involved in the procedure, including trocar placement and surgical description. Results: Between 2009 and 2019, a total of 8 patients with past history of RGC were operated with this technique. All patients had been previously operated by open method, 7 due to peptic ulcer disease and 1 due to gastric cancer. Their mean age at the time of the first surgery was 38.9 years (range 25-56 years) and the mean interval between the first and the second gastrectomy was 32.1 years (range 13.6-49). Billroth II was the previous reconstruction in all cases. A 5-trocar technique was used followed by total gastrectomy with side-to-side stapled intracorporeal esophagojejunostomy anastomosis and Roux-en-Y reconstruction. The mean operation time was 272 minutes (range 180-330) and median blood loss was 247 mL (range 50-500). There was no conversion and no major intraoperative complication. Major postoperative complications occurred in 3 patients. Conclusion: Completion total gastrectomy for RGC is a morbid procedure and laparoscopic access is technically feasible, hopefully carrying the benefits of faster recovery, reduced postoperative pain, and wound complications. By standardizing the approach, the learning curve may be shortened and better results achieved.
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Affiliation(s)
- Erica Sakamoto
- Cancer Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Andre Roncon Dias
- Cancer Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Amir Zeide Charruf
- Cancer Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Bruno Zilberstein
- Cancer Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Ivan Cecconello
- Cancer Institute, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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Laparoscopic Completion Total Gastrectomy as a Standardized Procedure for Gastric Stump Cancer: A Case Control Study. Int Surg 2021. [DOI: 10.9738/intsurg-d-20-00036.1] [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
Complete gastrectomy for gastric stump cancer (GSC) can be challenging due to severe adhesions; therefore, advanced techniques are required when being performed by laparoscopic surgery. This study aimed to evaluate the clinical outcomes of laparoscopic completion total gastrectomy (LCTG) for the treatment of GSC.
Methods
Patient records from January 2010 to October 2018 were retrospectively evaluated. The patients were classified into 2 groups depending on whether they underwent open or laparoscopic gastrectomy. We compared patient characteristics; operative, clinical, and pathological data between the groups.
Results
Twenty open and 17 LCTGs were performed. Laparoscopic gastrectomy resulted in a significantly longer operation time (230 versus 182.5 min; P = 0.026), lower blood loss (14 versus 105 mL; P < 0.001), and shorter period to the first flatus passage (2 versus 3 days; P < 0.001) than open gastrectomy. No significant differences in the number of retrieved lymph nodes, duration of hospital stay, complication rate, and postoperative analgesic usage between the 2 groups were observed. No patients required conversion to open surgery in the laparoscopic-treatment group. Pathologic findings revealed that the laparoscopic group had a smaller tumor size (not pathologic T category) and fewer metastatic lymph nodes than the open group, leading to an earlier distribution of the pathologic stage in the laparoscopic group.
Conclusions
LCTG for the treatment of GSC was safely conducted with fewer complications and mortalities than previously reported results. Advanced technologies and sophistication of laparoscopic skills may further yield minimal invasiveness with better short-term outcome.
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Kitadani J, Ojima T, Nakamura M, Hayata K, Katsuda M, Takeuchi A, Tominaga S, Fukuda N, Motobayashi H, Nakai T, Yamaue H. Safety and feasibility of laparoscopic gastrectomy for remnant gastric cancer compared with open gastrectomy: Single-center experience. Medicine (Baltimore) 2021; 100:e23932. [PMID: 33530194 PMCID: PMC7850663 DOI: 10.1097/md.0000000000023932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/27/2020] [Indexed: 01/05/2023] Open
Abstract
The usefulness, safety and oncological validity of laparoscopic gastrectomy (LG) for remnant gastric cancer (RGC) have not been widely reported.A total of 38 patients who underwent gastrectomy for RGC were enrolled at Wakayama Medical University Hospital between April 2008 and December 2018. All consecutive patients were included in this retrospective study; the patients were divided into the open gastrectomy group and the laparoscopic group according to the sequential nature of their operation. Fifteen patients underwent open gastrectomy for RGC (OGR) between April 2008 and December 2013, and 23 patients underwent LG for RGC (LGR) after 2014.In the OGR group, all initial operations were performed by open surgery, whereas in the LGR group, 11 patients (47%) initially underwent laparoscopic surgery and 12 patients (53%) initially underwent open surgery (P = .002), 3 patients of which (25%) converted to open gastrectomy. There was no significant difference in the number of lymph node dissections or in operative time between the 2 groups, but blood loss was significantly lower in the LGR group than that in the OGR group (P = .002). Furthermore, although there was no difference between the 2 groups in C-reactive protein value on postoperative day 1, C-reactive protein value on postoperative day 3 was significantly lower in the LGR group than in the OGR group (P = .012). There were no differences in postoperative complications or long-term outcomes, including recurrence-free survival and overall survival.LGy is suitable in cases in which the initial surgery is performed by laparoscopic surgery. Even if the initial surgery is open surgery, it is oncologically equivalent to open gastrectomy and can be performed safely with less blood loss.
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Ota M, Ikebe M, Shin Y, Kagawa M, Mano Y, Nakanoko T, Nakashima Y, Uehara H, Sugiyama M, Iguchi T, Sugimachi K, Yamamoto M, Morita M, Toh Y. Laparoscopic Total Gastrectomy for Remnant Gastric Cancer: A Single-institution Experience and Systematic Literature Review. In Vivo 2020; 34:1987-1992. [PMID: 32606171 DOI: 10.21873/invivo.11996] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM The safety and efficacy of laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) remains unclear. The purpose of this study was to compare the clinical outcomes of LTG with open total gastrectomy (OTG) for RGC. PATIENTS AND METHODS Twenty-two patients who underwent total gastrectomy for RGC were enrolled in this study. RESULTS LTG was carried out in seven patients, and OTG was performed in the remaining 15 patients. The mean operation time in the LTG group was longer than that in the OTG group. The estimated blood loss in the LTG group was less than that in the OTG group. No cases in the LTG group required open conversion. Postoperatively, the first meal and defecation were earlier in the LTG group than in the OTG group. The overall survival rates of the two groups were comparable. CONCLUSION Laparoscopic total gastrectomy is a feasible surgical option for RGC.
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Affiliation(s)
- Mitsuhiko Ota
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Masahiko Ikebe
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Yuki Shin
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Masaki Kagawa
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Yohei Mano
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Tomonori Nakanoko
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Yuichiro Nakashima
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Hideo Uehara
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Masahiko Sugiyama
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Tomohiro Iguchi
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Manabu Yamamoto
- Department of Surgery, Fukuoka Sanno Hospital, Fukuoka, Japan
| | - Masaru Morita
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
| | - Yasushi Toh
- Department of Gastrointestinal Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
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Zheng ZF, Lu J, Zheng CH, Huang CM. "Five-step" laparoscopic lymph node dissection for remnant gastric cancer following Billroth-II gastrectomy: A safe and feasible procedure. Surg Oncol 2019; 32:115-116. [PMID: 31874429 DOI: 10.1016/j.suronc.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 07/23/2019] [Accepted: 09/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Laparoscopic surgery (LS) for remnant gastric cancer (RGC) is gaining interest [1-3]. However, due to adhesions to adjacent organs, displacement of anatomical structures, and changes in lymphatic flow triangulation, LS for RGC is considered challenging. In this study, we report our experience performing laparoscopic lymph node dissection for RGC following Billroth-II gastrectomy. METHODS The procedure was separated into five steps: (1) exploration and separation of adhesions and the greater omentum; (2) dissection of the lymph nodes (LNs) in the suprapancreatic area; (3) exposing the right side of the esophagus; (4) exposing the left gastroepiploic vessels and dissection of the LNs in the splenic hilar area; and (5) exposing the left side of the esophagus. The above procedure was performed for 45 RGC patients with stage cT1-4aN0/+ disease from January 2008 to June 2017. RESULTS There were no conversions to open surgery. The mean operation time was 195.0 ± 52.5 min, the mean blood loss was 104.3 ± 90.4 ml, and the mean times to first flatus, fluid diet, and soft diet were 3.6 ± 1.1 days, 4.5 ± 1.4 days, and 9.0 ± 5.1 days, respectively. A mean of 19.8 ± 12.7 LNs were retrieved. The overall postoperative morbidity rate, major postoperative morbidity [4] rate and mortality rate were 22.2%, 11.1%, and 0%, respectively. At a median follow-up of 47 months, the cumulative 3-year overall survival rate was 56.8%. CONCLUSIONS This novel "five-step" laparoscopic lymph node dissection approach was technically safe and feasible in RGC patients following Billroth-II gastrectomy.
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Affiliation(s)
- Zhi-Fang Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Is Laparoscopic Approach Also Safe for the Treatment of Remnant Gastric Cancer? THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:3-4. [PMID: 35601704 PMCID: PMC8979842 DOI: 10.7602/jmis.2019.22.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 12/02/2022]
Abstract
The most important advantages of laparoscopic gastrectomy are the minimal invasiveness, including less postoperative pain, shorter recovery, and minimal complications. A laparoscopic distal gastrectomy is accepted widely as a standard treatment for gastric cancer. On the other hand, a laparoscopic total gastrectomy has not been popularized as a distal gastrectomy because of the complexity of a lymph node dissection and the diversity of reconstruction. In terms of laparoscopic surgery for a remnant gastrectomy, there are three key points, which are critical for safe operation: adequate lymph node dissection, meticulous adhesiolysis, and reconstruction. After radical surgery for gastric cancer, the intra-abdominal condition is greatly changed. In addition, the lymphatic anatomy around the stomach is broken and surgeons should be aware of a newly developed lymphatic system to perform adequate node dissection. An esophago-jejunal reconstruction is at risk of leakage. Until evidence that is more concrete can be obtained, experienced surgeons should consider the laparoscopic approach.
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Clinical Outcomes of Totally Laparoscopic Total Gastrectomy versus Open Total Gastrectomy for Remnant Gastric Cancer. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:29-38. [PMID: 35601702 PMCID: PMC9007718 DOI: 10.7602/jmis.2019.22.1.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 12/31/2022]
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Otsuka R, Hayashi H, Sakata H, Uesato M, Hayano K, Murakami K, Kano M, Fujishiro T, Toyozumi T, Semba Y, Matsubara H. Short-term clinical outcomes of laparoscopic gastrectomy for remnant gastric cancer: A single-institution experience and systematic review of the literature. Ann Gastroenterol Surg 2019; 3:181-186. [PMID: 30923787 PMCID: PMC6422809 DOI: 10.1002/ags3.12221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/26/2018] [Accepted: 10/14/2018] [Indexed: 12/19/2022] Open
Abstract
AIM Application of laparoscopic approaches for the treatment of remnant gastric cancers (RGC) is still controversial. Therefore, in the present study, the safety and effectiveness of laparoscopic gastrectomy (LG) for RGC was investigated. METHODS A total of 27 patients who underwent gastrectomy for RGC from June 2008 to September 2017 were enrolled in this study. A comprehensive review of the literature on LG for RGC published before December 2017 using the PubMed database was carried out. RESULTS Laparoscopic gastrectomy was carried out in seven patients, and open gastrectomy (OG) was done in the remaining 20 patients. LG was associated with significantly less intraoperative blood loss (70 ± 71 vs. 1066 ± 1428 g; P < 0.001), significantly more retrieved lymph nodes (22 ± 13 vs. 12 ± 9; P = 0.03), a relatively lower postoperative complication rate, and a relatively shorter postoperative hospital stay than OG. A comprehensive review of the literature showed that LG for RGC was more likely to correlate with longer operative time, less blood loss, lower postoperative complication rate, shorter postoperative hospital stay, and more retrieved lymph nodes than OG. CONCLUSION The clinical outcome of our patients with RGC and the literature indicated that a laparoscopic approach contributed to faster recovery after surgery than an open approach without sacrificing its radicality and was a safe and secure treatment option for RGC.
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Affiliation(s)
- Ryota Otsuka
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Hideki Hayashi
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Haruhito Sakata
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Masaya Uesato
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Koichi Hayano
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Kentaro Murakami
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Masayuki Kano
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Takeshi Fujishiro
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Takeshi Toyozumi
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Yoshihide Semba
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
| | - Hisahiro Matsubara
- Department of Frontier SurgeryGraduate School of MedicineChiba UniversityChibaJapan
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Booka E, Kaihara M, Mihara K, Nishiya S, Handa K, Ito Y, Shibutani S, Egawa T, Nagashima A. Laparoscopic total gastrectomy for remnant gastric cancer: A single-institution experience. Asian J Endosc Surg 2019; 12:58-63. [PMID: 29745474 DOI: 10.1111/ases.12495] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/12/2018] [Accepted: 03/25/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The incidence of remnant gastric cancer is increasing because of past use of subtotal gastrectomy to treat peptic ulcer and increased survival rates after radical gastrectomy for gastric cancer. The feasibility and advantages of laparoscopic total gastrectomy (LTG) for remnant gastric cancer remain unclear. Therefore, we aimed to investigate the safety, feasibility, and clinical short-term outcomes of LTG for remnant gastric cancer. METHODS Patients who underwent completion total gastrectomy for remnant gastric cancer between April 2007 and October 2017 were divided into two groups: the open total gastrectomy (OTG) group and the LTG group. Clinicopathological data and short-term outcomes were analyzed. RESULTS A total of 31 remnant gastrectomies (23 OTG, 8 LTG) were performed. Blood loss was significantly lower in the LTG group than in the OTG group (135.5 vs 568.3 mL, P = 0.013). However, there was no significant difference in the operation time, days to food intake, or length of hospital stay between the two groups. Additionally, there was no significant difference in the postoperative complications, number of retrieved lymph nodes, or pathological findings. Two LTG patients (25.0%) required conversion to open surgery. There was no mortality in either group. CONCLUSIONS LTG for remnant gastric cancer can be a safe treatment option and may have an advantage of less blood loss than OTG.
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Affiliation(s)
- Eisuke Booka
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Masaki Kaihara
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Koki Mihara
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shin Nishiya
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kan Handa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Yasuhiro Ito
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Shintaro Shibutani
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Tomohisa Egawa
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Atsushi Nagashima
- Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.,Department of Surgery, Saiseikai Kanagawaken Hospital, Yokohama, Japan
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The Feasibility of Laparoscopic Gastrectomy for Remnant Gastric Cancer. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00155.1] [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
We compared laparoscopic gastrectomy for remnant gastric cancer (LRG) with open gastrectomy for remnant gastric cancer (ORG) to assess the safety and invasive nature of LRG. This study was a retrospective study. The study population consisted of 27 consecutive patients who underwent gastrectomy for remnant gastric cancer. Of these, 15 underwent ORG between January 2003 and April 2007, and 12 underwent LRG between May 2007 and January 2013. The operation time was not significantly different between the 2 groups. However, blood loss was significantly less in the LRG group than in the ORG group. No intraoperative blood transfusion was required. There was no significant difference in morbidity rate between the LRG (1/12, 8.3%) and ORG (4/15, 26.7%) groups, and no patients died in either group. Body temperature on postoperative day (POD) 7 (P = 0.034); systolic blood pressure on PODs 6 (P = 0.042) and 7 (P = 0.035); and heart rate on POD 7 (P = 0.049) were significantly lower in the LRG group than in the ORG group. No significant differences were observed in white blood cell count, or C-reactive protein and serum albumin levels between the groups. Serum total protein levels were significantly higher on POD 1 (P = 0.020), and the number of lymphocytes was significantly higher on POD 7 in the LRG group than in the ORG group (P = 0.036). Pain scores on POD 7 were significantly lower in the LRG group than in the ORG group (P = 0.033). LRG is a technically feasible and safe procedure.
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16
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Shao XX, Tian YT. Evolution trends of indications for laparoscopic surgery in patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2017; 25:2754-2760. [DOI: 10.11569/wcjd.v25.i31.2754] [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] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery for gastric cancer has the advantages open surgery of less blood loss, shorter postoperative hospital stay, faster postoperative recovery and smaller scar and has been widely carried out worldwide. Since laparoscopic surgery for gastric cancer was carried out 20 years ago, the indications for laparoscopic gastric surgery has been expanding with the continuous progress of science and technology, the innovation of equipment, the improvement of the level of laparoscopic surgeons' awareness, and the obtainment of high quality clinical evidence. Here we review the evolution trends of indications for laparoscopic surgery in patients with gastric cancer.
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Affiliation(s)
- Xin-Xin Shao
- Department of Oncological Surgery, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University, Beijing 100010, China
| | - Yan-Tao Tian
- Department of Pancreatic and Stomach Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Yamashita K, Miyazaki Y, Takahashi T, Masuike Y, Motoori M, Kimura Y, Kurokawa Y, Makino T, Yamasaki M, Nakajima K, Takiguchi S, Mori M, Doki Y. Safety and feasibility of laparoscopic gastrectomy for gastric cancer patients with a history of abdominal surgery. Surg Today 2017; 47:1274-1281. [PMID: 28321575 DOI: 10.1007/s00595-017-1506-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the safety and feasibility of laparoscopic gastrectomy (LG) for gastric cancer patients with a history of abdominal surgery (HAS). METHODS This retrospective study analyzed data collected from gastric cancer patients with HAS, who underwent LG between 2004 and 2015. We compared the clinicopathological features that correlated with conversion to open surgery and the development of severe postoperative complications (Clavien-Dindo classification of grade III or higher). RESULTS Of the 41 patients identified, 6 (14.6%) required conversion to open surgery. The incidence of conversion to open surgery was associated with a history of lower gastrointestinal tract surgery (p = 0.009), attempted laparoscopic total gastrectomy (p = 0.002), and excessive blood loss (p < 0.001). Severe postoperative complications developed in six patients (14.6%). Although the development of complications was associated with high postoperative serum C-reactive protein, the type of past abdominal surgery was not significantly correlated with severe complications. CONCLUSIONS LG was feasible for gastric cancer patients with a HAS, but for those with a history of lower abdominal surgery or those who require total gastrectomy, surgeons should carefully consider the indications for LG.
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Affiliation(s)
- Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasunori Masuike
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Faculty of Medicine, Kinki University, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Liao G, Wen S, Xie X, Wu Q. Laparoscopic gastrectomy for remnant gastric cancer: Risk factors associated with conversion and a systematic analysis of literature. Int J Surg 2016; 34:17-22. [PMID: 27543820 DOI: 10.1016/j.ijsu.2016.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 07/30/2016] [Accepted: 08/10/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND In traditional opinion, history of abdominal surgery was the relative contraindication for Laparoscopic gastrectomy (LG) with high rate of conversion to Open gastrectomy (OG).Use of LG for treatment of remnant gastric cancer (RGC) has been documented in some case studies and controlled clinical trials. However, whether LG is superior, equal or inferior to OG in these patients is not clear. METHODS English language articles published between January 2005 and January 2016 were searched in MEDLINE, Embase and the Cochrane Database of Systematic Reviews. Main outcome measures were: conversion of LG to OG, operative time, intraoperative blood loss, tumor size, positive proximal resection margin, lymph node dissection, disease stage, post-operative resumption of oral intake, postoperative hospital stay, complications, mortality and follow-up findings. Published clinical data which was in the situation of conversion to OG was collected, and the factors associated with conversion to open surgery were examined. RESULTS Five non-randomized controlled trials and seven LG case studies were included in the systematic review. Meta-analysis of the data could not be performed due to high variation and heterogeneity in study design, study population, LG technique, and outcome measures among the included studies. Systematic analysis of the included studies showed that LG was associated with significantly shorter mean operative time, early resumption of oral intake, and shorter hospital stay, as compared to that with OG. No significant difference in complications was observed between the two groups. CONCLUSION LG in the hands of experienced surgeons is relative feasibility and safety for RGC. Previous surgical anastomosis, previous open surgery and surgical experience were associated with conversion to OG. However, these findings should be validated with robust prospective comparative studies.
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Affiliation(s)
- Guanqun Liao
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China.
| | - Shunqian Wen
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China
| | - Xueyi Xie
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China
| | - Qing Wu
- Department of General Surgery, Foshan Hospital Affiliated to Southern Medical University, Foshan, China
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A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition. Case Rep Surg 2016; 2016:9357659. [PMID: 27034881 PMCID: PMC4808533 DOI: 10.1155/2016/9357659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 12/21/2022] Open
Abstract
A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SM)N0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer's early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach.
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Tsunoda S, Okabe H, Tanaka E, Hisamori S, Harigai M, Murakami K, Sakai Y. Laparoscopic gastrectomy for remnant gastric cancer: a comprehensive review and case series. Gastric Cancer 2016; 19:287-92. [PMID: 25503677 DOI: 10.1007/s10120-014-0451-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/24/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Remnant gastric cancer is increasing with the earlier detection of gastric cancer and improved medical care. Laparoscopic gastrectomy for remnant gastric cancer has been reported sporadically in association with the increased use of minimally invasive techniques. However, because of the rarity of remnant gastric cancer, the number of cases reported per study has been small. We therefore reviewed all published English-language reports, including our experience, to better characterize the technical aspects of currently used procedures. METHODS Ten patients who underwent laparoscopic gastrectomy for remnant cancer between August 2005 and March 2014 were retrospectively studied. A comprehensive literature search was performed using the PubMed database to identify English-language studies on laparoscopic gastrectomy for remnant gastric cancer that were published before May 2014. RESULTS There was no conversion to open surgery. The mean operating time was 325 min, and mean intraoperative blood loss was 55 g. The mean number of retrieved lymph nodes was 22, and mean postoperative hospital stay was 13 days. There was only one minor wound infection (overall morbidity rate, 10%). From the literature review, all comparative studies revealed that laparoscopic gastrectomy for remnant gastric cancer required a longer operating time, and most studies reported less intraoperative blood loss, an equivalent number of harvested lymph nodes, and a shorter postoperative stay as compared with open surgery. CONCLUSION Proficiency in advanced laparoscopic surgical techniques, such as proper adhesiolysis and stable laparoscopic anastomosis, will allow laparoscopic gastrectomy for remnant gastric cancer to be performed with satisfactory short-term results. This minimally invasive approach can be one treatment option for remnant gastric cancer.
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Affiliation(s)
- Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Hiroshi Okabe
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Eiji Tanaka
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Motoko Harigai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Katsuhiro Murakami
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Kim DJ, Kim W. Laparoscopic completion total gastrectomy for remnant gastric cancer following pancreaticoduodenectomy for bile duct cancer: a case report. Ann Surg Treat Res 2015; 90:106-10. [PMID: 26878019 PMCID: PMC4751144 DOI: 10.4174/astr.2016.90.2.106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Abstract
Laparoscopic completion total gastrectomy following pancreaticoduodenectomy (PD) has not been reported. A 73-year-old male who underwent PD 25 years ago for distal common bile duct cancer visited a surgical department for remnant gastric cancer. A previous reconstruction was performed with pancreaticojejunostomy (PJ), gastrojejunostomy and Braun anastomosis, i.e., jejunojejunostomy (JJ), between the afferent and efferent jejunal limb to prevent bile reflux into the remnant stomach. Adhesiolysis was initially performed to secure the surgical view. Lymph node dissections around the splenic artery, splenic hilum, celiac axis, left gastric artery, and common hepatic artery were performed. The PJ site was well visualized and safely preserved. Esophagojejunostomy was performed with an OrVil system. Specimen retrieval, Roux-limb preparation and JJ were performed through an extended umbilicus trocar site. A final pathologic examination revealed a 5.5-cm serosa-exposed tumor (T4a) without lymph node metastasis. The patient was discharged on postoperative day 7 without any complications.
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Affiliation(s)
- Dong Jin Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Son SY, Lee CM, Jung DH, Lee JH, Ahn SH, Park DJ, Kim HH. Laparoscopic completion total gastrectomy for remnant gastric cancer: a single-institution experience. Gastric Cancer 2015; 18:177-82. [PMID: 24477417 DOI: 10.1007/s10120-014-0339-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/30/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the present study was to evaluate the feasibility of laparoscopic completion total gastrectomy (LCTG) in patients with remnant gastric cancer. METHODS Patients who underwent completion total gastrectomy for remnant gastric cancer between May 2003 and December 2012 were divided into two groups: an open completion total gastrectomy (OCTG) group and an LCTG group. Clinicopathological data, operative data, and patient survival rates were analyzed. RESULTS Thirty-four remnant gastrectomies (17 OCTG and 17 LCTG) were performed. The mean time interval between the prior gastrectomy and the remnant gastrectomy was 17.2 years, and benign disease showed a longer time interval than malignancy (30.9 vs. 8.1 years; p < 0.0001). LCTG required a longer operation time than OCTG (234.4 vs. 170.0 min; p = 0.002); however, there were no significant differences in the estimated blood loss, the number of retrieved lymph nodes, the time to first flatus passage, the length of hospital stay, complication rates, and postoperative analgesia between the two groups. Eight patients (47.1%) required conversion to open surgery during LCTG. The median overall survival was 69.1 months. There was no difference in 5-year survival between the two groups (p = 0.085). CONCLUSION LCTG was technically feasible; however, it showed no definitive clinical advantage over OCTG.
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Affiliation(s)
- Sang-Yong Son
- Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam, 463-707, Korea
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Pan Y, Mou YP, Chen K, Xu XW, Cai JQ, Wu D, Zhou YC. Three cases of laparoscopic total gastrectomy with intracorporeal esophagojejunostomy for gastric cancer in remnant stomach. World J Surg Oncol 2014; 12:342. [PMID: 25392032 PMCID: PMC4237785 DOI: 10.1186/1477-7819-12-342] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 10/20/2014] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer in remnant stomach is a rare tumor but with poor prognosis. Compared with conventional open surgery, laparoscopic gastrectomy has potential benefits for these patients due to advantages resulting from its minimally invasive approach. Herein, we report on three patients with gastric cancer in remnant stomach who underwent laparoscopic total gastrectomy with intracorporeal esophagojejunostomy successfully. The operative time was 280, 250 and 225 minutes, the estimated blood loss was 100, 80 and 50 ml and the length of postoperative hospital stay was seven, eight and nine days respectively. Our experience has suggested that laparoscopic total gastrectomy with intracorporeal esophagojejunostomy can be a safe, feasible and promising option for patients with gastric cancer in remnant stomach.
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Affiliation(s)
| | - Yi-Ping Mou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, Zhejiang Province, China.
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Minimally invasive surgery for remnant gastric cancer: a comparison with open surgery. Surg Endosc 2014; 28:2452-8. [PMID: 24622766 DOI: 10.1007/s00464-014-3496-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Completion total gastrectomy for remnant gastric cancer (RGC) is technically challenging, especially using the minimally invasive approach. Only a few small case series have reported the technical feasibility of completion total gastrectomy by minimally invasive surgery (MIS). The aim of this study was to compare the efficacy and safety of MIS and open surgery for RGC. METHODS We retrospectively analyzed 76 completion total gastrectomies for RGC between 2005 and 2012. Indications for MIS were limited to no evidence of serosa invasion or lymph node metastasis to extraperigastric areas on preoperative evaluation. We compared patient characteristics, intraoperative factors, post-operative outcomes, and survival for the MIS and open surgery groups. RESULTS Eighteen patients underwent completion total gastrectomy with MIS (10 laparoscopic, 8 robotic) and 58 patients underwent open surgery. Operation time was longer in the MIS than the open group (266 vs. 203 min, P = 0.004), but the groups had similar estimated blood loss, frequency of unplanned other organ resection, and number of retrieved lymph nodes. The MIS group had a significantly earlier initiation of soft diet, shorter hospital stay, and fewer pain medication injections. Complication rates, recurrence, and overall 5-year survival were similar for the two groups. When we compared laparoscopy with robotic, similar result was shown in all parameters except operation time. CONCLUSIONS Compared to open surgery, MIS for RGC demonstrated better short-term outcome and comparable oncologic results. MIS for RGC is feasible and safe and maintains advantages of minimal invasiveness. Both laparoscopic and robotic approaches are reasonable to the management of RGC.
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Nagai E, Nakata K, Ohuchida K, Miyasaka Y, Shimizu S, Tanaka M. Laparoscopic total gastrectomy for remnant gastric cancer: feasibility study. Surg Endosc 2013; 28:289-96. [PMID: 24013469 DOI: 10.1007/s00464-013-3186-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/06/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND The benefits and feasibility of laparoscopic surgery for remnant gastric cancer are still unclear. The purpose of this study was to describe the detailed procedure and to evaluate the clinical short-term outcomes of laparoscopic total gastrectomy (LTG) compared with open total gastrectomy (OTG) for remnant gastric cancer (RGC). METHODS Of 1,247 consecutive patients who underwent gastrectomy for gastric cancer in our department at Kyushu University Hospital from January 1996 to May 2012, 22 patients who underwent successful curative resection of RGC with precise nodal dissection were enrolled in this study. Twelve patients underwent LTG and the remaining ten patients underwent OTG. We analyzed the clinical short-term outcomes of LTG and compared the results between LTG and OTG groups to evaluate the safety and feasibility of LTG. RESULTS Twelve patients with RGC successfully underwent LTG without open conversion and morbidity. The mean operation time of LTG, 362.3 ± 68.4 min, was significantly longer than that of OTG (p = 0.0176), but the mean blood loss of LTG, 65.8 ± 62 g, was smaller than that of OTG (p < 0.01). The mean postoperative times to resumption of water and food intake were significantly shorter in the LTG group than in the OTG group (p < 0.01). The overall 3-year survival rate was comparable between the LTG and OTG groups (77.8 vs. 100 %; p = 0.9406). CONCLUSIONS This study shows that LTG is a feasible and reliable procedure for the treatment of RGC in terms of short-term outcomes.
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Affiliation(s)
- Eishi Nagai
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan,
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Totally laparoscopic complete resection of the remnant stomach for gastric cancer. Langenbecks Arch Surg 2012; 398:341-5. [PMID: 22777535 DOI: 10.1007/s00423-012-0979-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 06/25/2012] [Indexed: 12/29/2022]
Abstract
BACKGROUND In patients having carcinoma in the remnant stomach, total resection of the remnant stomach with lymph node dissection is a prerequisite. MATERIALS AND METHODS We present the first series of successful totally laparoscopic complete gastrectomy (TLCG) for gastric remnant cancer. RESULTS TLCG was successfully performed without adverse events during surgery in five patients with gastric remnant cancer. The median age of the patients was 72 years (range, 56-84 years), and there were three men and two women. Three of them had a Billroth I reconstruction and two had a Billroth II reconstruction, and in four cases following partial gastrectomy for gastric cancer and one for gastroduodenal ulcer. The median operative time was 360 min; blood loss was 20 ml. The median number of retrieved lymph nodes was 19. No complications occurred postoperatively, and all of the patients were discharged within the ninth postoperative day. CONCLUSIONS Although TLCG for gastric remnant cancer is a technically difficult and challenging operation that requires careful lysis of adhesion and dissection along the major vessels, as well as intracorporeal anastomosis, this procedure is technically feasible. Long-term follow-up is mandatory to validate oncological outcome.
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Laparoscopy-assisted completion total gastrectomy for gastric cancer in remnant stomach: report of 2 cases. Surg Laparosc Endosc Percutan Tech 2010; 19:e57-60. [PMID: 19390266 DOI: 10.1097/sle.0b013e31819cd62c] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The completion total gastrectomy is often performed in gastric cancer patients who have previously undergone distal gastrectomy owing to benign or malignant disease. This procedure includes not only removal of the remnant stomach, but also a lymphadenectomy in accordance with upper third gastric cancer. Although laparoscopy-assisted gastrectomy has been approved as one of the treatments of choice for early gastric cancer and its application has also been extend to advanced gastric cancer, only a few studies have reported on laparoscopy-assisted completion total gastrectomy. This is probably because the procedure is technically complicated procedure due to the intra-abdominal adhesion and anatomical changes. Recently, we successfully carried out laparoscopy-assisted completion total gastrectomy in 2 patients diagnosed with advanced gastric cancers in the remnant stomach. Distal gastrectomy was initially performed using laparoscopy-assisted and open procedures, respectively. Furthermore, we conducted the curative operations through a sufficiently extended lymphadenectomy or even through the resection of surrounding organs.
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Qian F, Yu PW, Hao YX, Sun G, Tang B, Shi Y, Zhao YL, Lan YZ, Luo HX, Mo A. Laparoscopy-assisted resection for gastric stump cancer and gastric stump recurrent cancer: a report of 15 cases. Surg Endosc 2010; 24:3205-9. [PMID: 20490555 DOI: 10.1007/s00464-010-1116-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study was designed to investigate the technical methods and clinical therapeutic effects of laparoscopy-assisted resection of gastric stump cancer (GSC). METHODS Laparoscopy-assisted resection was performed on 15 patients with GSC. The approach, method, difficult points, and techniques of the operation were analyzed, and its clinical therapeutic effect was evaluated. RESULTS With the help of laparoscopy, D2 radical resection of gastric stump was performed on 12 patients, and palliative gastric stump resection was performed on two patients. There was one case of conversion from laparoscopic surgery to open surgery. Roux-en-Y gastric bypass was performed in all cases to reconstruct the alimentary tract. The mean operative time for laparoscopy-assisted resection was 205 ± 25 min. The mean intraoperative blood loss volume was 110 ± 40 ml. The mean number of lymph nodes removed was 18 ± 5. A gastric tube was not placed in the patients after surgery. The mean time for the recovery of intestinal function was 2.5 ± 1 days, the mean duration of postoperative liquid diet was 2.5 ± 1 days, and the mean time for the recovery of ambulatory activity was 3 ± 0.5 days. There was one case of postoperative infection of the incision site. The follow-up time was 6-40 months, with 1 case of death due to liver metastasis, 1 case of death due to peritoneal metastasis, 1 case of death due to complications from lupus erythematosus, and survival for the remaining 12 cases. CONCLUSIONS Laparoscopy-assisted resection of GSC is technically feasible; determination of the short- and long-term efficacies will require a larger and comparative sample study.
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Affiliation(s)
- Feng Qian
- Department of General Surgery and Center of Minimally Invasive Gastrointestinal Surgery, Southwest Hospital, Third Military Medical University, Chongqing, 400038, People's Republic of China.
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Acceptability of Laparoscopy-assisted Gastrectomy for Patients With Previous Intra-abdominal Surgery. Surg Laparosc Endosc Percutan Tech 2009; 19:431-5. [DOI: 10.1097/sle.0b013e3181c30909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Laparoscopic approach to gastric remnant-stump: our initial successful experience on 3 cases. Surg Laparosc Endosc Percutan Tech 2008; 18:502-5. [PMID: 18936676 DOI: 10.1097/sle.0b013e31817f460b] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Laparoscopic treatment of gastric adenocarcinoma is still a debated issue. In this paper, we retrospectively reviewed 3 cases of laparoscopic treatment of gastric remnant-stump adenocarcinoma. We analyzed the feasibility, the postoperative outcome, and the short-term results. MATERIALS AND METHODS From January 2003 to September 2005, we carried out 3 laparoscopic completion gastrectomies for cancer of the remnant stomach. All patients were males, between 59 and 73 years old. All of them had a previous history of benign gastric ulcer that required a Billroth II subtotal gastrectomy. We always performed a D2 lymphadenectomy and a Roux an Y side-to-side esophagojejunostomy. RESULTS No conversion was necessary. Mean operative time was 210 minutes (range: 160 to 260 min). No intraoperative transfusions were applied. We had 1 postoperative bleeding managed conservatively with 2 units of blood transfusion. In 1 case, the esophageal transit study showed a tiny anastomotic leak, not clinically evident, which was managed conservatively. The mean peristalsis was present at 56 hours (range: 48 to 72 h). The mean postoperative stay was 11 days (range: 8 to 18 d). In all cases, histologic examination was positive for adenocarcinoma. The mean number of lymph nodes was 18 (range: 12 to 26). The TNM status was: T2N0M0, T3N0M0, and T3N1M0. Resection margins were negative in all cases (R0). The mean follow-up was 17.6 months (range: 11 to 24 mo). The patient with positive lymph node died 11 months after the operation for metastatic disease. CONCLUSIONS In our preliminary experience, laparoscopic treatment of gastric remnant-stump adenocarcinoma has been demonstrated to be technically feasible and sure. The histologic examination confirmed a proper surgical dissection. Also, if it is an initial experience, we believe that laparoscopy could be considered a valid opportunity to open surgery.
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