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Gu H, Li W, Zhou L. Application of hand-sewn esophagojejunostomy in laparoscopic total gastrectomy. World J Surg Oncol 2024; 22:73. [PMID: 38439060 PMCID: PMC10910664 DOI: 10.1186/s12957-024-03350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/24/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To investigate the clinical efficacy and prognostic implication of hand-sewn anastomosis in laparoscopic total gastrectomy (LTG). METHODS Retrospective analysis is adopted to the clinicopathologic data of 112 patients with gastric cancer (GC) who went through LTG in the Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University between October 2020 and October 2022. Among them, 60 individuals receiving medical care were split into the hand-sewn anastomosis group (Group H, N = 60); while, 52 individuals were split into the circular stapler anastomosis group (Group C, N = 52) The clinical efficacy and prognostic conditions of hand-sewn anastomosis are compared with those of circular stapler anastomosis in the application of LTG. RESULTS The analysis results indicated that no notable difference was observed in intraoperative bleeding volume, time to first flatus (TFF), postoperative hospitalization duration and postoperative complications among the two groups (P > 0.05). Group H had shorter esophagojejunal anastomosis duration (20.0 min vs. 35.0 min) and surgery duration (252.6 ± 19.4 min vs. 265.9 ± 19.8 min), smaller incisions (5.0 cm vs. 10.5 cm), and lower hospitalization costs (58415.0 CNY vs. 63382.5 CNY) compared to Group C (P < 0.05). CONCLUSION The clinical efficacy and the postoperative complications of hand-sewn esophagojejunostomy are basically equivalent in comparison to the circular stapler anastomosis in the application of LTG. Its advantage lies in shorter esophagojejunal anastomosis duration, shorter surgery duration, smaller incisions, lower hospitalization costs and wider adaptability of the location of the tumor.
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Affiliation(s)
- Hao Gu
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Weixiang Li
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Lianbang Zhou
- Department of General Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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2
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Li GZ, Ryou M, Thompson CC, Wang J. A Preclinical Study of an Esophagojejunal Compression Anastomosis After Total Gastrectomy with Self-Forming Magnets. J Gastrointest Surg 2023; 27:1710-1712. [PMID: 37059963 DOI: 10.1007/s11605-023-05664-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/06/2023] [Indexed: 04/16/2023]
Affiliation(s)
- George Z Li
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marvin Ryou
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher C Thompson
- Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Jiping Wang
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
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Yamauchi S, Kanda S, Yoshimoto Y, Kubota A, Tsuda K, Yube Y, Kaji S, Oka S, Orita H, Brock MV, Mine S, Fukunaga T. Double stapling technique versus hemi-double stapling technique for esophagojejunostomy with OrVil™ after laparoscopic total gastrectomy: a single-blind, randomized clinical trial. Surg Endosc 2023:10.1007/s00464-023-10068-z. [PMID: 37076615 DOI: 10.1007/s00464-023-10068-z] [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: 02/03/2023] [Accepted: 04/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND The transorally inserted anvil (OrVil™) is frequently selected for esophagojejunostomy after laparoscopic total gastrectomy (LTG) because of its versatility. During anastomosis with OrVil™, the double stapling technique (DST) or hemi-double stapling technique (HDST) can be selected by overlapping the linear stapler and the circular stapler. However, no studies have reported the differences between the methods and their clinical significance. METHODS A randomized controlled clinical trial with a parallel assignment and single-blind outcomes assessment analysis was conducted. Patients with gastric cancer eligible for LTG who met the selection criteria were randomized. Preoperative characteristics and perioperative and postoperative outcomes were compared between the DST and HDST. The primary endpoint was an anastomosis-related complication, and the secondary endpoints were perioperative outcomes and postoperative complications, excluding anastomosis-related complications. RESULTS Thirty patients with gastric cancer were eligible and randomized. LTG and esophagojejunostomy were successfully performed in all patients, without conversion to laparotomy. Preoperative characteristics, excluding preoperative chemotherapy, were not significantly different between the two groups. One anastomotic leakage of Clavien-Dindo classification grade ≥ IIIa was observed in the DST, although no significant difference was found between the two groups (6.6% vs. 0%, P = 0.30). In the HDST, one case of anastomotic stricture required endoscopic balloon dilation. No significant differences were found in operative time, whereas the anastomosis time was significantly shorter in the HDST than in the DST (47.5 ± 15.8 vs. 38.2 ± 8.8 min, P = 0.028). Except for anastomosis-related complications, postoperative complications (P = 0.282) and postoperative hospital stay for the DST and HDST were not significantly different. CONCLUSIONS No superiority was found between the DST and HDST with OrVil™ in esophagojejunostomy of LTG for gastric cancer with respect to postoperative complications, whereas the HDST may be preferable in terms of the simplicity of the surgical technique.
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Affiliation(s)
- Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan.
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Satoshi Kanda
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Akira Kubota
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Kenki Tsuda
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Shinichi Oka
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Hajime Orita
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Malcolm V Brock
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Faculty of Medicine, Juntendo University, 3-1-3 Hongo, Bunkyo-Ku, Tokyo, 113-8431, Japan
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Vos EL, Nakauchi M, Capanu M, Park BJ, Coit DG, Molena D, Yoon SS, Jones DR, Strong VE. Phase II Trial Evaluating Esophageal Anastomotic Reinforcement with a Biologic, Degradable, Extracellular Matrix after Total Gastrectomy and Esophagectomy. J Am Coll Surg 2022; 234:910-917. [PMID: 35426405 PMCID: PMC9128801 DOI: 10.1097/xcs.0000000000000113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND A biologic, degradable extracellular matrix (ECM) has been shown to support esophageal tissue remodeling, which could reduce the risk of anastomotic leak following total gastrectomy and esophagectomy. We evaluated the safety and efficacy of reinforcing the anastomosis with ECM in reducing anastomotic leak as compared to a matched cohort. STUDY DESIGN In this single-center, nonrandomized phase II trial, gastric or esophageal adenocarcinoma patients undergoing total gastrectomy or esophagectomy were recruited from November 2013 through December 2018. ECM was surgically wrapped circumferentially around the anastomosis. Anastomotic leak was assessed clinically and by contrast study and defined as clinically significant if requiring invasive treatment (grade 3 or higher). Anastomotic stenosis, other adverse events, symptoms, and dysphagia score were collected by standardized forms at regular follow-up visits at approximately postoperative days (POD) 21 and 90. Patients receiving ECM were compared to a cohort matched for surgery type and age. RESULTS ECM placement was not feasible in 9 of 75 patients (12%), resulting in 66 patients receiving ECM. Total gastrectomy was performed in 50 patients (76%) and esophagectomy in 16 (24%). Clinically significant anastomotic leak was diagnosed in 6 of 66 patients (9.1%) (3/50 [6.0%] after gastrectomy, 3/16 [18.8%] after esophagectomy); this rate did not differ from that in the matched cohort (p = 0.57). Stenosis requiring invasive treatment occurred in 8 patients (12.5%), and 10 patients (15.6%) reported not being able to eat a normal diet at POD 90. No adverse events related to ECM were reported. CONCLUSIONS Esophageal anastomotic reinforcement after total gastrectomy or esophagectomy with a biologic, degradable ECM was mostly feasible and safe, but was not associated with a statistically significant decrease in anastomotic leak.
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Affiliation(s)
- Elvira L Vos
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Masaya Nakauchi
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marinela Capanu
- Department of Surgery, Department of Epidemiology & Biostatistics (Capanu), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Coit
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel S Yoon
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service (Park, Molena, Jones), Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vivian E Strong
- From the Gastric and Mixed Tumor Service (Vos, Nakauchi, Coit, Yoon, Strong), Memorial Sloan Kettering Cancer Center, New York, NY
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Anastomotic Complications Can Be Reduced Using a Linear Stapler After Total Gastrectomy for Gastric Cancer. Indian J Surg 2022. [DOI: 10.1007/s12262-021-02894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Foley DM, Emanuwa EJE, Knight WRC, Baker CR, Kelly M, McEwan R, Zylstra J, Davies AR, Gossage JA. Analysis of outcomes of a transoral circular stapled anastomosis following major upper gastrointestinal cancer resection. Dis Esophagus 2021; 34:6130170. [PMID: 33554244 DOI: 10.1093/dote/doab004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Esophageal anastomoses performed following esophagectomy and total gastrectomy are technically challenging with a significant risk of anastomotic leak. A safe, reliable, and easy anastomotic technique is required to improve patient outcomes and reduce morbidity. METHOD This paper analyses 328 consecutive patients who underwent transoral circular stapled esophageal anastomosis (ORVIL™) from a prospectively collected single-center database between December 2011 and February 2019. RESULTS Two hundred and twenty-seven esophagectomies and 101 gastrectomies were performed using OrVil™ anastomoses. The mean patient age was 63.7 years. Of 328 consecutive OrVil™-based anastomoses, there were 10 clinically significant anastomotic leaks requiring radiological or operative intervention (3.05%). Twenty-eight (8.54%) patients developed anastomotic stricture, all of which were successfully treated with endoscopic balloon dilatation (a median of 1 dilatation was required per patient). CONCLUSION The OrVil™ anastomotic technique is reliable and safe to perform. This is the largest reported series of the OrVil™ anastomotic technique to date. Leak rates and anastomotic dilations were similar to other reported series. Based on our experience, we consider the use of the OrVil™ device for reconstruction after major upper GI resection to be safe and reliable.
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Affiliation(s)
- Daniel M Foley
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - William R C Knight
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Cara R Baker
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Kelly
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ricardo McEwan
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Janine Zylstra
- Department of Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Hong F, Wang Y, Zhang Y, Li S, Shan F, Jia Y, Li Z, Ji J. Comparison of the short-term outcomes of laparoscopic and open total or proximal gastrectomy using the transorally inserted anvil (OrVil TM) for the proximal reconstruction: a propensity score matching analysis. Langenbecks Arch Surg 2021; 406:651-658. [PMID: 33629127 DOI: 10.1007/s00423-021-02126-8] [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: 11/04/2020] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the short-term surgical outcomes of laparoscopic and open total/proximal gastrectomy using transorally inserted anvil (OrVilTM). METHOD Patients diagnosed with gastric cancer and underwent total or proximal gastrectomy using OrVilTM for reconstruction were included. Clinical and pathological characteristics, as well as postoperative outcomes, were analyzed. Propensity score matching was used to balance baseline factors. RESULTS From April 2012 to April 2020, 199 patients at our center were included. A total of 166 underwent open total or proximal gastrectomy (OTG/OPG), and 33 underwent laparoscopic total or proximal gastrectomy (LTG/LPG). Twenty-seven patients from each group were paired with propensity score matching. The operation time was significantly shorter in the OTG/OPG group after matching. The overall complication rate and the incidence of each complication did not show significant differences between the two groups before and after matching. CONCLUSION LTG/LPG and OTG/OPG using OrVilTM for the alimentary tract reconstruction are both feasible and can achieve similar short-term outcomes.
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Affiliation(s)
- Fanling Hong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yinkui Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Shuangxi Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Yongning Jia
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Ziyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Jiafu Ji
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
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Wang J, Yang J, Yang XW, Li XH, Yang JJ, Ji G. Comparison of Outcomes of Totally Laparoscopic Total Gastrectomy (Overlap Reconstruction) versus Laparoscopic-Assisted Total Gastrectomy for Advanced Siewert III Esophagogastric Junction Cancer and Gastric Cancer of Upper and Middle Third of Stomach: Study Protocol for a Single-Center Randomized Controlled Trial. Cancer Manag Res 2021; 13:595-604. [PMID: 33519239 PMCID: PMC7837541 DOI: 10.2147/cmar.s285598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Totally laparoscopic total gastrectomy (TLTG) using the overlap reconstruction method is associated with fewer postoperative complications and fast recovery than laparoscopic-assisted radical total gastrectomy (LATG). However, evidence on the safety and feasibility of TLTG (overlap reconstruction) in patients with advanced Siewert III esophagogastric junction cancer and gastric cancer of the upper and middle third of the stomach is scarce. Methods This study is a prospective, single-center, single-blind, two-arm randomized controlled trial designed to include 292 patients with advanced Siewert III esophagogastric junction cancer and gastric cancer of the upper and middle third of the stomach who will be randomly assigned to two groups: a TLTG overlap group (n=146) and an LATG group (n=146). The patients’ demographics, pathological characteristics, intraoperative variables, postoperative complications, postoperative recovery variables, 3-year disease-free survival and 3-year overall survival will be collected and analyzed. The primary outcome is the postoperative complications within 30 days after surgery including intra-abdominal hemorrhage, anastomotic leakage, duodenal stump fistula, pancreatic fistula, chyle leakage, abdominal infection, intestinal obstruction, wound complications, pulmonary infection, pleural effusion, pulmonary embolism, cardiovascular and cerebrovascular complications, and deep vein thrombosis. The secondary outcomes are the 3-year disease-free survival and 3-year overall survival. Discussion This trial will provide high-level evidence for the safety and feasibility of TLTG (overlap reconstruction) compared with LATG in advanced Siewert III esophagogastric junction cancer and the upper and middle third of gastric cancer. Trial Registration This trial has been registered at the Chinese Clinical Trial Registry: ChiCTR1900025667 (registration date: September 4, 2019).
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Affiliation(s)
- Juan Wang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jun Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xue Wen Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Xiao Hua Li
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Jian Jun Yang
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
| | - Gang Ji
- Department of Digestive Surgery, Xi Jing Hospital, The Fourth Military Medical University, Xi'an, People's Republic of China
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Huang C, Zhao J, Liu Z, Huang J, Zhu Z. Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique. Front Oncol 2020; 10:575. [PMID: 32373537 PMCID: PMC7186791 DOI: 10.3389/fonc.2020.00575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Totally laparoscopic total gastrectomy (TLTG) not only is difficult to operate but also has high technical requirements and a long learning curve. Therefore, it has not been widely carried out yet, and esophagojejunostomy is one of its difficulties. Relevant studies have shown that intracorporeal hand-sewn esophagojejunostomy is safe, feasible and low-cost, but it is complicated and time-consuming and requires a high-suture technique. This study introduces a simple, safe and feasible hand-sewn technique. Methods: The clinical data of 32 patients with the esophageal suspension method for hand-sewn esophagojejunostomy (suspension group) after TLTG were collected from February 2018 to June 2019. During the same period, 32 patients with traditional hand-sewn esophagojejunostomy (traditional group) after TLTG were used as the control group. Results: The operative time, anastomosis time, exhaust time and hospitalization time of the suspension group were shorter than those of the traditional group. The intraoperative blood loss in the suspension group was less than that in the traditional group. There were no postoperative complications associated with the suspension group. Conclusion: For those who have some experience in laparoscopic suture technique, the esophageal suspension method for hand-sewn esophagojejunostomy after TLTG is a simple, safe, and feasible suture technique.
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Affiliation(s)
- Chao Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiefeng Zhao
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zitao Liu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jun Huang
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhengming Zhu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Ishibashi Y, Oka S, Kanda S, Yube Y, Kohira Y, Kaji S, Egawa H, Jianzhong W, Zhang S, Fukunaga T. Hemi-double stapling technique performed with a transorally inserted anvil for esophagojejunostomy in the surgical treatment of gastric cancer. Asian J Endosc Surg 2020; 13:168-174. [PMID: 31099183 DOI: 10.1111/ases.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 03/28/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into place during laparoscopic total gastrectomy (LTG). We describe a hemi-double stapling technique and application of a transorally inserted anvil for esophagojejunostomy during LTG, and we report the results of a retrospective study in which we examined the feasibility and safety of this method. We also describe the key technical details of the method. METHODS Our anastomotic method has four chief features: (a) the esophagus is cut at a slant, and its left cut end is cut and punched for the hemi-double stapling technique; (b) the anvil and circular stapler are connected, placing the distal jejunum in cranial traction; (c) a single layer of sutures is used to correct dog-earing and overlapping, and these points are completely closed with Lembert sutures; and (d) the jejunal limb is fixed to the duodenal stump to prevent kinking of the jejunal limb and to decrease tension on the anastomosis. RESULTS This method has been used in 53 patients thus far. LTG with Roux-en-Y reconstruction was successful in all patients, and there was no need for conversion to open surgery. The mean operative time was 313 minutes, and the mean blood loss was 106 mL. The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis. CONCLUSION Hemi-double stapling technique with a transorally inserted anvil for LTG can be performed safely and easily and safely. It can also product good outcomes.
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Affiliation(s)
- Yuji Ishibashi
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinichi Oka
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Satoshi Kanda
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukinori Yube
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshinori Kohira
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Sanae Kaji
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroki Egawa
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Wu Jianzhong
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Shun Zhang
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tetsu Fukunaga
- Department of Gastroenterology and Minimally Invasive Surgery, Juntendo University School of Medicine, Tokyo, Japan
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11
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Li Z, Dong J, Huang Q, Zhang W, Tao K. Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study. World J Surg Oncol 2019; 17:209. [PMID: 31810484 PMCID: PMC6898954 DOI: 10.1186/s12957-019-1762-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/26/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The incidence of adenocarcinoma of esophagogastric junction (AEG) has recently risen worldwide, including in Eastern Asia. The aim of the study was to explore the short-term and long-term clinical efficacy of piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR), piggyback jejunal interposition reconstruction double-tract reconstruction (PJIRDTR), and total gastrectomy esophageal jejunal Roux-en-Y anastomosis (TGRY) for the treatment of Siewert II and III AEG patients. METHODS A total of 300 Siewert II and III AEG patients admitted to Shanxi Tumor Hospital from June 2015 to December 2017 were prospectively selected. Patients were randomly divided into PJIRSTR group (n = 98), PJIRDTR group (n = 103), and TGRY group (n = 99) using the random number table method. RESULTS There were no statistically significant differences in total operation time, intraoperative blood loss, time of first anal exhaust, and postoperative hospital stay among the three groups (F = 2.526, 0.457, 0.234, 0.453; P > 0.05). The reconstruction time of PJIRSTR group and PJIRDTR group was longer than that of TGRY group (P < 0.01). There were no significant differences in cases of anastomotic leakage, anastomotic bleeding, abdominal infection, incision infection, ileus, and dumping syndrome in three groups (P > 0.05). The incidence of reflux esophagitis at 3, 6, 12, and 18 months after surgery in the PJIRSTR group and the PJIRDTR group were significantly lower than TGRY group in the same period (P < 0.05). Compared with PJIRDTR group and TGRY group, PJIRSTR group had a small fluctuation range of postoperative nutrition indexes and had basically recovered to the preoperative level at 18 months. Four patients of Visick grade IV presented in TGRY group 18 months postoperatively, which was significantly higher compared with the other two groups. CONCLUSION Compared with PJIRDTR and TGRY, PJIRSTR can significantly reduce the incidence of postoperative reflux esophagitis and improve the long-term nutritional status of patients. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IIR-16007733. Registered 07 November 2015 - Retrospectively registered, http://www.chictr.org.cn/searchproj.aspx.
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Affiliation(s)
- Zhiguo Li
- Department of Minimal Invasive Digestive Surgery, Shanxi Tumor Hospital, Shanxi Medical University, Taiyuan, 030013, China
| | - Jianhong Dong
- Department of Minimal Invasive Digestive Surgery, Shanxi Tumor Hospital, Shanxi Medical University, Taiyuan, 030013, China.
| | - Qingxing Huang
- Department of Minimal Invasive Digestive Surgery, Shanxi Tumor Hospital, Shanxi Medical University, Taiyuan, 030013, China
| | - Wanhong Zhang
- Department of Minimal Invasive Digestive Surgery, Shanxi Tumor Hospital, Shanxi Medical University, Taiyuan, 030013, China
| | - Kai Tao
- Department of Minimal Invasive Digestive Surgery, Shanxi Tumor Hospital, Shanxi Medical University, Taiyuan, 030013, China
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12
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Zhang Z, Lin J, Zhuang L, Kang M. Combined laparoscopic and thoracoscopic Ivor Lewis esophagectomy using the transorally inserted anvil-the experience of Fujian Medical University Union Hospital. J Thorac Dis 2019; 11:2567-2570. [PMID: 31372294 DOI: 10.21037/jtd.2019.05.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zhenyang Zhang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China
| | - Jiangbo Lin
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China
| | - Linwei Zhuang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China
| | - Mingqiang Kang
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350000, China.,Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou 350122, China.,Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou 350122, China
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13
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Kawaguchi Y, Shiraishi K, Akaike H, Ichikawa D. Current status of laparoscopic total gastrectomy. Ann Gastroenterol Surg 2019; 3:14-23. [PMID: 30697606 PMCID: PMC6345655 DOI: 10.1002/ags3.12208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022] Open
Abstract
In this article, the current state of laparoscopic total gastrectomy (LTG) was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes. Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection. Considering reconstruction, there are two major esophagojejunostomy (EJS) techniques, using a circular stapler (CS) or using a linear stapler (LS). A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity (such as anastomotic leakage and stricture) is not significantly different for the two methods. As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical. Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach.
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Affiliation(s)
- Yoshihiko Kawaguchi
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Kensuke Shiraishi
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Hidenori Akaike
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Daisuke Ichikawa
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
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14
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Sindayigaya R, Guizani M, Thébault B, Dussart D, Abou Mrad Fricquegnon A, Piquard A, Saint-Marc O. Robot-Assisted Total Gastrectomy: Preliminary Evaluation. J Laparoendosc Adv Surg Tech A 2019; 29:589-594. [PMID: 30596541 DOI: 10.1089/lap.2018.0659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Laparoscopic total gastrectomy with extended lymphadenectomy is a technically demanding surgical procedure with steep learning curve that has limited its widespread use. The aim of this study was to evaluate the feasibility of the robotic approach in total gastrectomy for cancer. We present our experience of 17 consecutive patients who underwent robotic total gastrectomy with intracorporal sutured Roux-en-Y esophagojejunostomy and jejuno jejunostomy between 2014 and 2017. Methods: Data were collected, and patients' demographics and outcomes were examined retrospectively. Results: Seventeen patients with a median age of 68 years (range 32-81) were identified (10 males, 7 females). Mean operative time was 198 minutes (range 108-277) including mean anastomosis time of 25 minutes (range 18-35). There was no conversion to open surgery or requirement for perioperative blood transfusion. Median length of hospital stay was 9 days (range 2-30). Two patients developed postoperative complications including one anastomotic leakage treated conservatively and one internal hernia requiring surgical revision. There was no 90-day mortality or readmission. Conclusion: Robot-assisted total gastrectomy is feasible and reproducible. It overcomes several laparoscopic technical difficulties especially regarding anastomosis. It has the potential to become an alternative to open gastrectomy for gastric cancer. Nevertheless, further follow-up and randomized clinical trials are needed to evaluate mid-term and long-term outcomes of this approach.
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Affiliation(s)
- Rémy Sindayigaya
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - Marwen Guizani
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - Baudouin Thébault
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - David Dussart
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - Adel Abou Mrad Fricquegnon
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - Arnaud Piquard
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
| | - Olivier Saint-Marc
- Service de Chirurgie Digestive, Endocrinienne et Thoracique, Centre Hospitalier Régional, Orleans, France
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15
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Kunisaki C, Miyamoto H, Sato S, Tanaka Y, Sato K, Izumisawa Y, Yukawa N, Kosaka T, Akiyama H, Saigusa Y, Sakamaki K, Yamanaka T, Endo I. Surgical Outcomes of Reduced-Port Laparoscopic Gastrectomy Versus Conventional Laparoscopic Gastrectomy for Gastric Cancer: A Propensity-Matched Retrospective Cohort Study. Ann Surg Oncol 2018; 25:3604-3612. [PMID: 30178393 DOI: 10.1245/s10434-018-6733-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The technical feasibility and oncologic efficacy of reduced-port laparoscopic gastrectomy (RPG) for gastric cancer remain unclear. METHODS A series of 767 patients with gastric cancer who underwent R0 laparoscopic gastrectomy were retrospectively matched for age, gender, American Society of Anesthesiology score, body mass index, surgeon, lymph node dissection, and pathologic stages by propensity scoring. Finally, data from 274 patients (74 conventional laparoscopic distal gastrectomy [CLDG] cases, 74 reduced-port distal gastrectomy [RPDG] cases, 63 conventional laparoscopic total gastrectomy [CLTG] cases, and 63, reduced-port total gastrectomy [RPTG] cases) were selected for analysis. RESULTS Compared with the conventional group, the reduced-port group had significantly longer operation times (RPDG 265 min vs CLDG 239 min; p = 0.001 and RPTG 305 min vs CLTG 285 min; p = 0.012) and reduced blood loss (RPDG 48 ml vs CLDG 68 ml; p = 0.001 and RPTG 75 ml vs CLTG 110 ml; p = 0.026). The number of dissected lymph nodes was significantly higher in the CLDG group than in the RPDG group (38 vs 31; p = 0.002). Cosmetic satisfaction showed significant superiority in the reduced-port group compared with the conventional group. No significant difference was observed in overall survival (OS) (5-year OS: RPDG 100% vs CLDG 96.7%; p = 0.207 and RPTG 91.6% vs CLTG 91.8%; p = 0.615) or relapse-free survival (RFS) (5-year RFS: RPTG 92.3% vs CLTG 92.1%; p = 0.587). CONCLUSIONS The study results suggest that RPG for gastric cancer by an experienced surgeon is a feasible and safe technique. The RPG procedure can be presented to patients as one of the effective treatment options.
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Affiliation(s)
- Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
| | - Hiroshi Miyamoto
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Sho Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Yusaku Tanaka
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Kei Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Yusuke Izumisawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Takashi Kosaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan.,Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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16
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Felder SI, Ramanathan R, Russo AE, Jimenez-Rodriguez RM, Hogg ME, Zureikat AH, Strong VE, Zeh HJ, Weiser MR. Robotic gastrointestinal surgery. Curr Probl Surg 2018; 55:198-246. [PMID: 30470267 DOI: 10.1067/j.cpsurg.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 07/26/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Seth I Felder
- Department of Gastrointestinal Surgery, Moffitt Cancer Center, Tampa, Florida
| | - Rajesh Ramanathan
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashley E Russo
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Melissa E Hogg
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Amer H Zureikat
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Herbert J Zeh
- Division of Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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17
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Jimenez-Rodriguez RM, Weiser MR. In Brief. Curr Probl Surg 2018. [DOI: 10.1067/j.cpsurg.2018.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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18
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Norero E, Funke R, Garcia C, Fernandez JI, Lanzarini E, Rodriguez J, Ceroni M, Crovari F, Pinto G, Musleh M, Gonzalez P. National Trend in Laparoscopic Gastrectomy for Gastric Cancer: Analysis of the National Register in Chile. Dig Surg 2018; 35:461-468. [PMID: 29669338 DOI: 10.1159/000485197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 11/09/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The laparoscopic approach for the treatment of gastric cancer has many advantages. However, outside Asia there are few large case series. AIM To evaluate postoperative morbidity, long-term survival, changes in indication, and the results of laparoscopic gastrectomy. METHODS We included all patients treated with a laparoscopic gastrectomy from 2005 to 2014. We compared results across 2 time periods: 2005-2011 and 2012-2014. Median follow-up was 39 months. RESULTS Two hundred and eleven patients underwent a laparoscopic gastrectomy (median age 64 years, 55% male patients). In 135 (64%) patients, a total gastrectomy was performed. Postoperative morbidity occurred in 29%. A significant increase in the indication of laparoscopic surgery for stages II-III (32 vs. 45%; p = 0.04) and higher lymph node count (27 vs. 33; p = 0.002) were observed between the 2 periods. The 5-year overall survival was 72%. According to the stage, the 5-year overall survival was 85, 63, and 54% for stage I, II, and III respectively (p < 0.001). CONCLUSIONS There was an acceptable rate of postoperative complications and the long-term survival was in accordance with the disease stage. There was a higher indication of laparoscopic surgery in stages II-III disease, and higher lymph node count in the latter period of this study.
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Affiliation(s)
- Enrique Norero
- Digestive Surgery Department, Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Funke
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Garcia
- Hospital San Borja Arriaran, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Enrique Lanzarini
- Hospital Clínico Universidad de Chile, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | | | - Marco Ceroni
- Digestive Surgery Department, Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Gerardo Pinto
- Hospital El Pino, Faculty of Medicine, Universidad Andres Bello, Santiago, Chile
| | - Maher Musleh
- Hospital Clínico Universidad de Chile, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Paulina Gonzalez
- Digestive Surgery Department, Hospital Dr. Sotero del Rio, Esophagogastric Surgery Unit, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
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19
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Gong W, Li J. Combat with esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer: A critical review of the literature. Int J Surg 2017; 47:18-24. [PMID: 28935529 DOI: 10.1016/j.ijsu.2017.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/14/2017] [Accepted: 09/10/2017] [Indexed: 02/06/2023]
Abstract
Esophagojejunal anastomotic leakage (EJAL) is considered to be one of the most serious complications after total gastrectomy (TG), despite improvements in surgical instruments and technique. The occurrence of EJAL would cause poorer quality of life, prolonged hospital stay, and increased surgery-related costs and mortality. Although there is ever-increasing knowledge about EJAL, the optimal management is controversial. In the present review, we aim to demonstrate the effective management by focus on the possible risk factors, potentially useful preventive strategies, and several kinds of treatments in esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer.
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Affiliation(s)
- Wenbin Gong
- School of Medicine, Southeast University, Nanjing, China.
| | - Junsheng Li
- Department of General Surgery, Affiliated Zhongda Hospital, Nanjing, China
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20
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Norero E, Muñoz R, Ceroni M, Manzor M, Crovari F, Gabrielli M. Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer. J Gastric Cancer 2017; 17:267-276. [PMID: 28970957 PMCID: PMC5620096 DOI: 10.5230/jgc.2017.17.e26] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/05/2017] [Accepted: 07/20/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. Materials and Methods This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. Results We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36–87) years. The average operative time was 337±71 minutes and intraoperative bleeding was 160±107 mL. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6–29) days. Conclusions Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.
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Affiliation(s)
- Enrique Norero
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Muñoz
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marco Ceroni
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Manzor
- Esophagogastric Surgery Unit, Digestive Surgery Department, Hospital Dr. Sotero del Rio, Pontificia Universidad Católica de Chile, Santiago, Chile.,Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Crovari
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Gabrielli
- Digestive Surgery Department, Hospital Clínico Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Santiago, Chile
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Yasukawa D, Hori T, Kadokawa Y, Kato S, Machimoto T, Hata T, Aisu Y, Sasaki M, Kimura Y, Takamatsu Y, Ito T, Yoshimura T. Impact of stepwise introduction of esophagojejunostomy during laparoscopic total gastrectomy: a single-center experience in Japan. Ann Gastroenterol 2017; 30:564-570. [PMID: 28845113 PMCID: PMC5566778 DOI: 10.20524/aog.2017.0157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022] Open
Abstract
Background The number of laparoscopic gastrectomies performed in Japan is increasing with the development of laparoscopic and surgical instruments. However, laparoscopic total gastrectomy is developing relatively slowly because of technical difficulties, particularly in esophagojejunostomy. Methods We retrospectively reviewed 83 patients with early gastric cancer in the upper portion of the stomach who underwent laparoscopic total gastrectomy between April 2007 and March 2016. We classified the patients into three periods, mainly on the basis of the esophagojejunostomy procedures performed: first period, various conventional procedures based on the physicians’ choice (n=14); second period, transoral method (n=51); and third period, fully intracorporeal technique (n=18). We evaluated the clinical impact of a stepwise introduction of unfamiliar new methods during laparoscopic total gastrectomy. Results Between the first and second periods, there were significant differences in the blood loss volume, number of harvested lymph nodes, frequency of conversion to open surgery, and postoperative hospital stay. The number of harvested lymph nodes was significantly higher in the third than in the second period, with no detriment to other intraoperative or postoperative factors. Conclusion The use of a unified surgical method for esophagojejunostomy seems to be the key to a successful and advantageous laparoscopic total gastrectomy. Stepwise introduction of a well-established technique of esophagojejunostomy during laparoscopic total gastrectomy will benefit patients, as shown, for example, by the higher number of dissected lymph nodes in the present study. However, a protracted learning curve is required.
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Affiliation(s)
- Daiki Yasukawa
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tomohide Hori
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Shigeru Kato
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuki Aisu
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Maho Sasaki
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
| | - Tsunehiro Yoshimura
- Department of Gastrointestinal and General Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Japan
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22
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Comparison of OrVil™ and RPD in laparoscopic total gastrectomy for gastric cancer. Surg Endosc 2017; 31:4773-4779. [PMID: 28409368 DOI: 10.1007/s00464-017-5554-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/28/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Laparoscopic total gastrectomy (LTG) is frequently performed for treating patients with gastric cancer; however, the absence of anastomotic techniques with greater superiority has impaired its popularization. We have compared two types of anastomotic techniques with regard to technical perspectives and clinical outcomes. METHODS We reviewed 43 patients with gastric cancer who underwent LTG. Two types of anastomotic techniques have been applied after LTG-the trans-orally inserted anvil (OrVil™) and the reverse puncture device (RPD). Data on the type of anastomosis, blood loss, operation time, anastomosis time, location of tumors, distance between the top border of tumors and top resection margin, diameter of tumor, length of postoperative hospital stay, early and late postoperative complications, and total cost of surgical consumables were obtained by reviewing patient medical records and analyzed thereafter. RESULTS We included 32 men and 11 women (mean age 61 years). The loss to follow-up rate was 13.2%. The median survival time for the OrVil™ and RPD groups was 23 and 22 months, respectively. The total rate of complications was 9.3%. The difference in the anastomosis times between the groups was statistically significant. OrVil™ required more time than RPD and cost more than RPD. CONCLUSIONS Both the OrVil™ and RPD techniques showed good safety and applicability in LTG. RPD showed an advantage with regard to lesser operative complexity and lower cost.
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Kodera Y. The current state of stomach cancer surgery in the world. Jpn J Clin Oncol 2016; 46:1062-1071. [DOI: 10.1093/jjco/hyw117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Jovine E, Nicosia S, Masetti M, Lombardi R, Benini C, Di Saverio S. Novel Use of Surgical Glove Port to Perform Laparoscopic Total Gastrectomy. J Am Coll Surg 2016; 223:e35-41. [PMID: 27423399 DOI: 10.1016/j.jamcollsurg.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/03/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Elio Jovine
- Department of General Surgery, CA Pizzardi Maggiore Hospital, Bologna, Italy
| | - Simone Nicosia
- Department of General Surgery, CA Pizzardi Maggiore Hospital, Bologna, Italy
| | - Michele Masetti
- Department of General Surgery, CA Pizzardi Maggiore Hospital, Bologna, Italy
| | - Raffaele Lombardi
- Department of General Surgery, CA Pizzardi Maggiore Hospital, Bologna, Italy
| | - Claudia Benini
- Department of General Surgery, CA Pizzardi Maggiore Hospital, Bologna, Italy
| | - Salomone Di Saverio
- Department of General Surgery, CA Pizzardi Maggiore Hospital, Bologna, Italy.
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Kunisaki C, Makino H, Yamaguchi N, Izumisawa Y, Miyamato H, Sato K, Hayashi T, Sugano N, Suzuki Y, Ota M, Tsuburaya A, Kimura J, Takagawa R, Kosaka T, Ono HA, Akiyama H, Endo I. Surgical advantages of reduced-port laparoscopic gastrectomy in gastric cancer. Surg Endosc 2016; 30:5520-5528. [PMID: 27198549 DOI: 10.1007/s00464-016-4916-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/02/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although a few studies have reported the use of reduced-port laparoscopic gastrectomy (RPG) in gastric cancer patients, the feasibility of routinely using this technique remains unclear. It is therefore important to evaluate the surgical advantages of this technique in this patient group. METHODS Between August 2010 and July 2015, 165 patients underwent RPGs at our hospital, performed by a single surgeon. Of these patients, 88 underwent reduced-port laparoscopic distal gastrectomy (RPLDG) and 77 underwent reduced-port laparoscopic total gastrectomy (RPLTG). In addition to short-term surgical outcomes after RPG, survival times and the surgical learning curve were also evaluated. RESULTS Blood losses during lymph node dissection in the RPLDG and RPLTG groups were not significantly different (p = 0.160). Conversion to open surgery was necessary in only two patients. Postoperative morbidities were observed in 14.8 % of the RPLDG group and 14.3 % of the RPLTG group, but there were no deaths. Most patients expressed high cosmetic satisfaction in both groups. In the RPLDG group, operation time during reconstruction decreased over the first 50 cases and then plateaued, as the surgeon's experience of the technique increased. In contrast, in the RPLTG group, operation times dropped with surgical experience for both lymph node dissection, plateauing after 40 cases, and for reconstruction, plateauing after 30 cases. Only three patients died of gastric cancer in the follow-up period and three patients died of other diseases. Five-year overall survival and 5-year disease-specific survival were 95.6 and 98.0 %, respectively. CONCLUSIONS We have shown that reduced-port gastrectomy (RPG) could be an acceptable and satisfactory procedure for treating gastric cancer for an experienced laparoscopic gastric surgeon who has sufficient previous experience of conventional laparoscopic gastrectomies.
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Affiliation(s)
- Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hirochika Makino
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Naotaka Yamaguchi
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yusuke Izumisawa
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Hiroshi Miyamato
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Kei Sato
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Tsutomu Hayashi
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Nobuhiro Sugano
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yoshihiro Suzuki
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Akira Tsuburaya
- Department of Surgery, Gastroenterological Center, Yokohama City University, Chikara Kunisaki, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Jun Kimura
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Ryo Takagawa
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Kosaka
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Hidetaka Andrew Ono
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
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Choi AH, Arrington A, Falor A, Nelson RA, Lew M, Chao J, Lee B, Kim J. Assessment of the Double-Staple Technique for Esophagoenteric Anastomosis in Gastric Cancer. J Gastrointest Surg 2016; 20:688-92. [PMID: 26831060 PMCID: PMC4916499 DOI: 10.1007/s11605-016-3087-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/18/2016] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Reports on outcomes after double-staple technique (DST) for total and proximal gastrectomy are limited, originating mostly from Asian centers. Our objective was to examine anastomotic leak and stricture with DST for esophagoenteric anastomosis in gastric cancer patients. METHODS A single institution review was performed for patients who underwent total/proximal gastrectomy with DST between 2006 and 2015. DST was performed using transoral anvil delivery (OrVil) with end-to-end anastomosis. Clinical characteristics and outcomes, including anastomotic leak and stricture, were recorded. RESULTS Overall, DST was performed in 60 patients [total gastrectomy (81.7%, n = 49/60), proximal gastrectomy (10.0%, n = 6/60), and completion gastrectomy (8.3%, n = 5/60)]. Neoadjuvant chemotherapy was administered to 21 patients (35.0%), and 6 patients (10.0%) received external beam radiation therapy prior to completion gastrectomy. Operative approach was open (51.7%, n = 31/60), laparoscopic (43.3%, n = 26/60), or robotic (5.0%, n = 3/60). Anastomotic leak occurred in 6.7% (n = 4/60), while stricture independent of leak was identified in 19.0% (n = 11/58) of patients. Complications occurred in 38.3% (n = 23/60) of patients, of which 52% were classified as Clavien-Dindo grades III-V complications. CONCLUSION In the largest Western series of DST for esophagoenteric anastomoses in gastric cancer surgery, our experience demonstrates that DST is safe and effective with low rates of leak and stricture.
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Affiliation(s)
- Audrey H. Choi
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Amanda Arrington
- Department of Surgery, Marshall University Edwards Comprehensive Cancer Center, Huntington, WV, USA
| | - Ann Falor
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Rebecca A. Nelson
- Departments of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA
| | - Michael Lew
- Departments of Anesthesia, City of Hope National Medical Center, Duarte, CA, USA
| | - Joseph Chao
- Departments of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Byrne Lee
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Joseph Kim
- Division of Surgical Oncology, Department of Surgery, SUNY Stony Brook, New York, NY, USA
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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Nakauchi M, Suda K, Kadoya S, Inaba K, Ishida Y, Uyama I. Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc 2015; 30:4632-9. [PMID: 26703126 DOI: 10.1007/s00464-015-4726-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/15/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND D2 total gastrectomy combined with splenectomy or pancreaticosplenectomy reportedly increases morbidity and mortality. Totally laparoscopic total gastrectomy (TLTG) for advanced gastric cancer (AGC) remains controversial because of its technical difficulties and lack of long-term results. We determined the feasibility and safety of TLTG for AGC. METHODS A single-institution retrospective study was conducted. Ninety-two consecutive AGC patients who underwent radical TLTG were enrolled. The primary end point was morbidity. The patients were observed for 3 years following TLTG. We assessed short-term surgical and long-term outcomes, including 3-year overall survival rates (3yOS) and 3-year recurrence-free survival rates (3yRFS). RESULTS Early and late morbidities (Clavien-Dindo grade ≥3) were 26.1 and 6.5 %, respectively. Operative time, estimated blood loss, number of dissected lymph nodes, and postoperative hospital stay were 444 (278-694) min, 100 (0-2267) g, 48 (16-89), and 23 (9-136) days, respectively, and 3yOS and 3yRFS rates were 70.7 and 60.9 %, respectively. Factors associated with postoperative complications and 3yOS were operative time [OR 1.011 (1.006-1.017), p < 0.01] and cancer recurrence within 3 years [HR 312.191 (1.126-86573.245], p = 0.045], respectively. 3yRFS was associated with tumor size (≥50 mm) [HR 10.325 (1.328-80.289), p = 0.026], pathological N factor ≥2 [HR 3.188 (1.196-8.495), p = 0.02], and postoperative pancreatic fistula combined with intra-abdominal abscesses Clavien-Dindo grade ≥2; [HR 3.670 (1.440-9.351), p = 0.006]. CONCLUSIONS TLTG for AGC is sufficiently feasible and safe from both surgical and oncological point of view.
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Affiliation(s)
- Masaya Nakauchi
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Koichi Suda
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Shinichi Kadoya
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuki Inaba
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Yoshinori Ishida
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Ichiro Uyama
- Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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Kitagami H, Morimoto M, Nakamura K, Watanabe T, Kurashima Y, Nonoyama K, Watanabe K, Fujihata S, Yasuda A, Yamamoto M, Shimizu Y, Tanaka M. Technique of Roux-en-Y reconstruction using overlap method after laparoscopic total gastrectomy for gastric cancer: 100 consecutively successful cases. Surg Endosc 2015; 30:4086-91. [PMID: 26701704 DOI: 10.1007/s00464-015-4724-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND We have established a standard procedure for Roux-en-Y (RY) reconstruction in laparoscopic total gastrectomy (LTG) using esophagojejunostomy by the overlap method (OL). We report on our RY reconstruction technique and special approaches, and evaluate the usefulness of our reconstruction method based on the surgical results of 100 patients we have experienced to date. METHODS We performed LTG in 100 patients with gastric cancer. After total gastrectomy using five ports, the resected stomach was extracted through a small laparotomy. Through that, we performed sacrifice of the jejunum, Y limb anastomosis, creation of the lifted jejunum. As the OL, a side-to-side anastomosis of the lifted jejunum to the esophageal stump was laparoscopically performed using a linear stapler in an isoperistaltic direction, and the entry hole was closed with full-thickness suturing. The lifted jejunum was fixed with suture to the duodenal stump at a location where the esophagojejunostomy site was made linear, and the duodenal stump was buried. The mesenteric gap was laparoscopically closed with suture. RESULTS The median operative time in 100 patients undergoing LTG was 385 min, the median blood loss was 65 mL, and the median time required for the OL was 32 min. The mean hospitalization period was 10 days, and postoperative complications included bleeding requiring reoperation in one patient; other complications such as pancreatic fistula in five patients (5 %) were treated conservatively. No complication associated with anastomosis occurred. CONCLUSION In RY reconstruction using the OL, there were no complications associated with the anastomosis site in 100 consecutive patients, such as anastomotic leak or stenosis, indicating that it is a very useful and safe reconstruction method.
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Affiliation(s)
- Hidehiko Kitagami
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan.
| | - Mamoru Morimoto
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Kenichi Nakamura
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Takahiro Watanabe
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Yo Kurashima
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Keisuke Nonoyama
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Kaori Watanabe
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Shiro Fujihata
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Akira Yasuda
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Yasunobu Shimizu
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
| | - Moritsugu Tanaka
- Department of Surgery, KARIYA TOYOTA General Hospital, 5-15 Sumiyoshi-cho, Kariya City, Aichi Prefecture, 448-8505, Japan
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Amisaki M, Kihara K, Endo K, Suzuki K, Nakamura S, Sawata T, Shimizu T. Comparison of single-stapling and hemi-double-stapling methods for intracorporeal esophagojejunostomy using a circular stapler after totally laparoscopic total gastrectomy. Surg Endosc 2015; 30:2994-3000. [DOI: 10.1007/s00464-015-4588-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/19/2015] [Indexed: 12/16/2022]
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Kunisaki C, Makino H, Kimura J, Takagawa R, Ota M, Kosaka T, Akiyama H, Endo I. Application of reduced-port laparoscopic total gastrectomy in gastric cancer preserving the pancreas and spleen. Gastric Cancer 2015; 18:868-75. [PMID: 25398519 DOI: 10.1007/s10120-014-0441-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The feasibility of using reduced-port laparoscopic total gastrectomy (RPLTG) for the treatment of gastric cancer remains unclear. This study aimed to address the potentially important advantages of this surgical technique. METHODS Between April 2002 and February 2014, 90 patients underwent laparoscopy-assisted total gastrectomies, performed by a single surgeon. Of these, 45 patients underwent RPLTG and 45 patients underwent conventional laparoscopy-assisted total gastrectomy (CLATG). Short-term outcomes were compared to evaluate the feasibility of RPLTG for gastric cancer. RESULTS There were several significant differences between the RPLTG and CLATG groups in short-term outcomes: the mean total operation durations were significantly longer in the RPLTG group (319.0 min) than in the CLATG group (259.0 min). However, the mean volume of blood loss, the degree of lymph node dissection, and the number of dissected lymph nodes did not differ between the two groups. CONCLUSIONS We have shown that RPLTG could be an acceptable and satisfactory procedure for the treatment of gastric cancer requiring total gastrectomy for surgeons sufficiently experienced in CLATG.
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Affiliation(s)
- Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hirochika Makino
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Jun Kimura
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Ryo Takagawa
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Mitsuyoshi Ota
- Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan
| | - Takashi Kosaka
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Hirotoshi Akiyama
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan
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Inokuchi M, Otsuki S, Fujimori Y, Sato Y, Nakagawa M, Kojima K. Systematic review of anastomotic complications of esophagojejunostomy after laparoscopic total gastrectomy. World J Gastroenterol 2015; 21:9656-9665. [PMID: 26327774 PMCID: PMC4548127 DOI: 10.3748/wjg.v21.i32.9656] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/02/2015] [Accepted: 07/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the anastomotic complications of esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG), we reviewed retrospective studies.
METHODS: A literature search was conducted in PubMed for studies published from January 1, 1994 through January 31, 2015. The search terms included “laparoscopic,”“total gastrectomy,” and “gastric cancer.” First, we selected 16 non-randomized controlled trials (RCTs) comparing LTG with open total gastrectomy (OTG) and conducted an updated meta-analysis of anastomotic complications after total gastrectomy. The Newcastle-Ottawa scoring system (NOS) was used to assess the quality of the non-RCTs included in this study. Next, we reviewed anastomotic complications in 46 case studies of LTG to compare the various procedures for EJS.
RESULTS: The overall incidence of anastomotic leakage associated with EJS was 3.0% (30 of 984 patients) among LTG procedures and 2.1% (31 of 1500 patients) among OTG procedures in the 16 non-RCTs. The incidence of anastomotic leakage did not differ significantly between LTG and OTG (odds OR = 1.42, 95%CI: 0.86-2.33, P = 0.17, I2 = 0%). Anastomotic stenosis related to EJS was reported in 72 (2.9%) of 2484 patients, and the incidence was 3.2% among LTG procedures and 2.7% among OTG procedures. The incidence of anastomotic stenosis related to EJS was slightly, but not significantly, higher in LTG than in OTG (OR = 1.55, 95%CI: 0.94-2.54, P = 0.08, I2 = 0%). The various procedures for LTG were classified into six categories in the review of case studies of LTG. The incidence of EJS leakage was similar (1.1% to 3.2%), although the incidence of EJS stenosis was relatively high when the OrVilTM device was used (8.8%) compared with other procedures (1.0% to 3.6%).
CONCLUSION: The incidence of anastomotic complications associated with EJS was not different between LTG and OTG. Anastomotic stenosis was relatively common when the OrVilTM device was used.
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Lu X, Hu Y, Liu H, Mou T, Deng Z, Wang D, Yu J, Li G. Short-term outcomes of intracorporeal esophagojejunostomy using the transorally inserted anvil versus extracorporeal circular anastomosis during laparoscopic total gastrectomy for gastric cancer: a propensity score matching analysis. J Surg Res 2015; 200:435-43. [PMID: 26421708 DOI: 10.1016/j.jss.2015.08.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/15/2015] [Accepted: 08/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND To assess the short-term outcomes of intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil (OrVil) compared with extracorporeal circular Roux-en-Y anastomosis during laparoscopic total gastrectomy (LTG) for gastric cancer. METHODS From January 2011-April 2014, a total of 165 consecutive patients with gastric cancer underwent either intracorporeal Roux-en-Y esophagojejunostomy (n = 25) using the Orvil or extracorporeal circular anastomosis (n = 140) during LTG. After generating propensity scores with six covariates, including gender, age, body mass index (BMI), Eastern Cooperative Oncology Group performance status, tumor location, and tumor size, 25 patients undergoing the OrVil method (intracorporeal group) were one-to-one matched with 25 patients undergoing the extracorporeal method (extracorporeal group). The short-term outcomes were compared between the two groups. RESULTS Both groups were balanced regarding baseline variables. The total operative time was not significantly different between the two groups (216.5 ± 24.9 min versus 224.0 ± 30.5 min, P = 0.344), whereas either the duration of anvil insertion (9.9 ± 2.4 min versus 12.9 ± 2.0 min, P < 0.001) or reconstruction completion (44.4 ± 9.4 min versus 50.1 ± 5.4 min, P = 0.012) in the intracorporeal group was less. The mean length of minilaparotomy in the intracorporeal group was shorter (5.6 ± 0.4 cm versus 7.2 ± 1.7 cm, P < 0.001). No significant differences were observed in intraoperative complication rate, estimated blood loss, length of proximal margin, or postoperative recovery course (including the time to first flatus, liquid resumption, liquid, and soft diet) between the two groups. No patients suffered from anastomosis-related complications. The overall morbidity rates of 28.0% in the intracorporeal group and 32.0% in the extracorporeal group were comparable (P = 0.758). CONCLUSIONS Intracorporeal Roux-en-Y esophagojejunostomy using the transorally inserted anvil system may be a safe procedure during LTG for gastric cancer. However, a longer follow-up in a well-designed randomized controlled trial is necessary to more thoroughly evaluate this technique.
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Affiliation(s)
- Xin Lu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Yanfeng Hu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Zhenwei Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Da Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jiang Yu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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Wang H, Hao Q, Wang M, Feng M, Wang F, Kang X, Guan WX. Esophagojejunostomy after laparoscopic total gastrectomy by OrVil TM or hemi-double stapling technique. World J Gastroenterol 2015; 21:8943-8951. [PMID: 26269685 PMCID: PMC4528038 DOI: 10.3748/wjg.v21.i29.8943] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 03/25/2015] [Accepted: 05/07/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility, advantages and disadvantages of two types of anvil insertion techniques for esophagojejunostomy after laparoscopic total gastrectomy.
METHODS: This was an open-label prospective cohort study. Laparoscopy-assisted radical total gastrectomy with D2 lymph node dissection was performed in 84 patients with primary non-metastatic gastric cancer confirmed by pre-operative histological examination. Overweight patients were excluded, as well as patients with peritoneal dissemination and invasion of adjacent organs. After total gastrectomy, all patients were randomized into two groups. Patients in Group I underwent esophagojejunostomy using a transorally-inserted anvil (OrVilTM), while patients in Group II underwent esophagojejunostomy using the hemi-double stapling technique (HDST). Both types of esophagojejunostomy were performed under laparoscopy. Patients’ baseline characteristics, preoperative characteristics, perioperative characteristics, short-term postoperative outcomes and operation cost were compared between the two groups. The primary endpoint was evaluation of the surgical outcome (operating time, time of digestive tract reconstruction and time of anvil insertion) and the medical cost of each operation (operation cost and total cost of hospitalization). The secondary endpoints were time to solid diet, post-surgical hospitalization time, time to defecation, time to ambulation and intra-operative blood loss. In addition, complications were assessed and compared.
RESULTS: Laparoscopic total gastrectomy and esophagojejunostomy were successfully performed in all 84 patients, without conversion to laparotomy. There were no significant differences in the operative time and time for total gastrectomy between the two groups (287.8 ± 38.4 min vs 271.8 ± 46.1 min, P = 0.09, and 147.7 ± 31.6 min vs 159.8 ± 33.8 min, P = 0.09, respectively). The time for digestive tract reconstruction and for anvil insertion were significantly decreased in Group II compared with Group I (47.8 ± 12.1 min vs 55.4 ± 15.7 min, P = 0.01, and 12.6 ± 4.7 min vs 18.7 ± 7.5 min, P = 0.001, respectively). Intra-operative blood loss (96.4 ± 32.7 mL vs 88.2 ± 36.9 mL, P = 0.28), time to defecation (3.5 ± 0.9 d vs 3.2 ± 1.1 d, P = 0.12), time to ambulation (3.9 ± 0.7 d vs 3.6 ± 1.1 d, P = 0.12), time to solid diet (7.6 ± 1.4 d vs 8.0 ± 2.7 d, P = 0.31) and total hospitalization (10.6 ± 2.6 d vs 10.8 ± 3.5 d, P = 0.80) were similar between the two groups. In addition, the total costs of hospitalization were similar between the two groups (73848.7 ± 11781.0 RMB vs 70870.3 ± 14003.5 RMB, P = 0.296), but operation cost was significantly higher in Group I compared with Group II (32401.9 ± 1981.6 RMB vs 26961.9 ± 2293.8 RMB, P < 0.001).
CONCLUSION: Anvil insertion was faster and easier using the HDST technique compared with OrVilTM, and was more cost-effective. There was no significant difference in safety.
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Selby LV, Sjoberg DD, Cassella D, Sovel M, Weiser MR, Sepkowitz K, Jones DR, Strong VE. Comparing surgical infections in National Surgical Quality Improvement Project and an Institutional Database. J Surg Res 2015; 196:416-20. [PMID: 25840487 DOI: 10.1016/j.jss.2015.02.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 02/19/2015] [Accepted: 02/27/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Surgical quality improvement requires accurate tracking and benchmarking of postoperative adverse events. We track surgical site infections (SSIs) with two systems; our in-house surgical secondary events (SSE) database and the National Surgical Quality Improvement Project (NSQIP). The SSE database, a modification of the Clavien-Dindo classification, categorizes SSIs by their anatomic site, whereas NSQIP categorizes by their level. Our aim was to directly compare these different definitions. MATERIALS AND METHODS NSQIP and the SSE database entries for all surgeries performed in 2011 and 2012 were compared. To match NSQIP definitions, and while blinded to NSQIP results, entries in the SSE database were categorized as either incisional (superficial or deep) or organ space infections. These categorizations were compared with NSQIP records; agreement was assessed with Cohen kappa. RESULTS The 5028 patients in our cohort had a 6.5% SSI in the SSE database and a 4% rate in NSQIP, with an overall agreement of 95% (kappa = 0.48, P < 0.0001). The rates of categorized infections were similarly well matched; incisional rates of 4.1% and 2.7% for the SSE database and NSQIP and organ space rates of 2.6% and 1.5%. Overall agreements were 96% (kappa = 0.36, P < 0.0001) and 98% (kappa = 0.55, P < 0.0001), respectively. Over 80% of cases recorded by the SSE database but not NSQIP did not meet NSQIP criteria. CONCLUSIONS The SSE database is an accurate, real-time record of postoperative SSIs. Institutional databases that capture all surgical cases can be used in conjunction with NSQIP with excellent concordance.
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Affiliation(s)
- Luke V Selby
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel D Sjoberg
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Danielle Cassella
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mindy Sovel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kent Sepkowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.
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Selby LV, Vertosick EA, Sjoberg DD, Schattner MA, Janjigian YY, Brennan MF, Coit DG, Strong VE. Morbidity after Total Gastrectomy: Analysis of 238 Patients. J Am Coll Surg 2015; 220:863-871.e2. [PMID: 25842172 DOI: 10.1016/j.jamcollsurg.2015.01.058] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical quality improvement requires well-defined benchmarks and accurate reporting of postoperative adverse events, which have not been well defined for total gastrectomy. STUDY DESIGN Detailed postoperative outcomes on 238 patients who underwent total gastrectomy with curative intent, from 2003 to 2012, were reviewed by a dedicated surgeon chart reviewer to establish 90-day patterns of adverse events. RESULTS Of the 238 patients with stage I to III gastric adenocarcinoma who underwent curative-intent total gastrectomy, the median age was 66 years, and 68% were male. Median body mass index was 28 kg/m(2), and 68% of patients had at least 1 medical comorbidity. Forty-three percent of our patients received neoadjuvant chemotherapy, and 34% received postoperative adjuvant chemotherapy. Over the 90-day study period, 30-day mortality was 2.5% (6 of 238), and 90-day mortality was 2.9% (7 of 238). At least 1 postoperative adverse event was documented in 62% of patients, with 28% of patients experiencing a major adverse event requiring invasive intervention. The readmission rate was 20%. Anemia was the most common adverse event (20%), followed by wound complications (18%). The most common major adverse event was esophageal anastomotic leak, which required invasive intervention in 10% of patients. CONCLUSIONS This analysis has defined comprehensive 90-day patterns in postoperative adverse events after total gastrectomy with curative intent in a Western population. This benchmark allows surgeons to measure, compare, and improve outcomes and informed consent for this surgical procedure.
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Affiliation(s)
- Luke V Selby
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily A Vertosick
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mark A Schattner
- Department of Medicine, Gastroenterology and Nutrition Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yelena Y Janjigian
- Department of Medicine, Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Murray F Brennan
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel G Coit
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vivian E Strong
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY.
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Kelly KJ, Selby L, Chou JF, Dukleska K, Capanu M, Coit DG, Brennan MF, Strong VE. Laparoscopic Versus Open Gastrectomy for Gastric Adenocarcinoma in the West: A Case-Control Study. Ann Surg Oncol 2015; 22:3590-6. [PMID: 25631063 DOI: 10.1245/s10434-015-4381-y] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Data on laparoscopic gastrectomy in patients with gastric cancer in the Western hemisphere are lacking. This study aimed to compare outcomes following laparoscopic versus open gastrectomy for gastric adenocarcinoma at a Western center. METHODS Eighty-seven consecutive patients who underwent laparoscopic gastrectomy from November 2005 to April 2013 were compared with 87 patients undergoing open resection during the same time period. Patients were matched for age, stage, body mass index, and procedure (distal subtotal vs. total gastrectomy). Endpoints were short- and long-term perioperative outcomes. RESULTS Overall, 65 patients (37 %) had locally advanced disease, and 40 (23 %) had proximal tumors. The laparoscopic approach was associated with longer operative time (median 240 vs.165 min; p < 0.01), less blood loss (100 vs.150 mL; p < 0.01), higher rate of microscopic margin positivity (9 vs.1 %; p = 0.04), decreased duration of narcotic and epidural use (2 vs. 4 days, p = 0.04, and 3 vs. 4 days, p = 0.02, respectively), decreased minor complications in the early (27 vs. 16 %) and late (17 vs. 7 %) postoperative periods (p < 0.01), decreased length of stay (5 vs. 7 days; p = 0.01), and increased likelihood of receiving adjuvant therapy (82 vs. 51 %; p < 0.01). There was no difference in the number of lymph nodes retrieved (median 20 in both groups), major morbidity, or 30-day mortality. CONCLUSIONS Laparoscopic gastrectomy for gastric adenocarcinoma is safe and effective for select patients in the West.
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Affiliation(s)
- Kaitlyn J Kelly
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Luke Selby
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Joanne F Chou
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Katerina Dukleska
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Daniel G Coit
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Vivian E Strong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Yajima K, Kanda T, Kosugi SI, Kano Y, Ishikawa T, Ichikawa H, Hanyu T, Wakai T. Intrathoracic esophagojejunostomy using OrVil™ for gastric adenocarcinoma involving the esophagus. World J Gastrointest Surg 2014; 6:235-240. [PMID: 25548608 PMCID: PMC4278145 DOI: 10.4240/wjgs.v6.i12.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 10/09/2014] [Accepted: 11/19/2014] [Indexed: 02/07/2023] Open
Abstract
AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrVil™.
METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrVil™was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009, we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus.
RESULTS: The median operation time was 314 min (range; 210-367 min), and median blood loss was 210 mL (range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3 (range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. The median hospital stay was 16 d (range: 15-20 d). The median length of esophageal involvement was 14 mm (range: 6-48 mm) and that of the resected esophagus was 40 mm (range: 35-55 mm); all resected specimens had tumor-free margins.
CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.
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The overlap method is a safe and feasible for esophagojejunostomy after laparoscopic-assisted total gastrectomy. World J Surg Oncol 2014; 12:392. [PMID: 25527860 PMCID: PMC4364598 DOI: 10.1186/1477-7819-12-392] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 12/03/2014] [Indexed: 02/06/2023] Open
Abstract
Background Laparoscopic procedures are increasingly being applied to gastric cancer surgery, including total gastrectomy for tumors located in the upper gastric body. Even for expert surgeons, esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) can be technically challenging. We perform the overlap method of esophagojejunostomy after LATG for gastric cancer. However, technical questions remain. Is the overlap method safer and more useful than other anastomosis techniques, such as methods using a circular stapler? In addition, while we perform this overlap reconstruction after LATG in a deep and narrow operative field, can the overlap method be performed safely regardless of body habitus? This study aimed to evaluate these issues retrospectively and to review the literature. Methods From October 2005 to August 2013, we performed LATG with lymph-node dissection and Roux-en-Y reconstruction using the overlap method in 77 patients with gastric cancer. This study examined pre-, intra- and postoperative data. Results Mean operation time, time to perform anastomosis, and estimated blood loss were 391.4 min, 36.3 min, and 146.9 ml, respectively. There were no deaths, and morbidity rate was 13%, including one patient (1%) who developed anastomotic stenosis. Mean postoperative hospitalization was 13.4 days. Surgical outcomes did not differ significantly by body mass index. Conclusions First, the overlap method for esophagojejunostomy after LATG is safe and useful. Second, this method can be performed irrespective of the body type of the patient. In particular, in a deep and narrow operative field, the overlap method is more versatile than other anastomosis methods. We believe that the overlap method can become a standard reconstruction technique for esophagojejunostomy after LATG.
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Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T, Akiyama Y, Wakabayashi G. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 2014; 38:102-12. [PMID: 25458736 DOI: 10.1016/j.asjsur.2014.09.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 04/01/2014] [Accepted: 09/23/2014] [Indexed: 12/12/2022] Open
Abstract
There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs) methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001) and stenosis (8.3% vs. 1.8%, p < 0.001) of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, Japan.
| | - Keisuke Koeda
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | | | - Yusuke Kimura
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Takeshi Iwaya
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Yuji Akiyama
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Go Wakabayashi
- Department of Surgery, Iwate Medical University, Morioka, Japan
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Antonakis PT, Ashrafian H, Isla AM. Laparoscopic gastric surgery for cancer: Where do we stand? World J Gastroenterol 2014; 20:14280-14291. [PMID: 25339815 PMCID: PMC4202357 DOI: 10.3748/wjg.v20.i39.14280] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 05/29/2014] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer poses a significant public health problem, especially in the Far East, due to its high incidence in these areas. Surgical treatment and guidelines have been markedly different in the West, but nowadays this debate is apparently coming to an end. Laparoscopic surgery has been employed in the surgical treatment of gastric cancer for two decades now, but with controversies about the extent of resection and lymphadenectomy. Despite these difficulties, the apparent advantages of the laparoscopic approach helped its implementation in early stage and distal gastric cancer, with an increase on the uptake for distal gastrectomy for more advanced disease and total gastrectomy. Nevertheless, there is no conclusive evidence about the laparoscopic approach yet. In this review article we present and analyse the current status of laparoscopic surgery in the treatment of gastric cancer.
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Afaneh C, Abelson J, Schattner M, Janjigian YY, Ilson D, Yoon SS, Strong VE. Esophageal reinforcement with an extracellular scaffold during total gastrectomy for gastric cancer. Ann Surg Oncol 2014; 22:1252-7. [PMID: 25319574 DOI: 10.1245/s10434-014-4125-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Indexed: 01/21/2023]
Abstract
BACKGROUND Esophagojejunal (EJ) anastomotic leaks after total gastrectomy (TG) for malignancy lead to significant morbidity and mortality, thus affecting long-term survival. Preclinical and clinical trials have shown promise in utilizing degradable extracellular matrix (ECM) scaffolds in buttressing anastomoses. We describe our experience buttressing the EJ anastomosis after TG with a ECM scaffold. METHODS From February 2012 to January 2014, a total of 37 consecutive patients underwent TG buttressing of the EJ anastomosis with the degradable ECM scaffold composed of a porcine urinary bladder called MatriStem (ACell Inc.). The scaffold was circumferentially wrapped around the EJ anastomosis. The primary end point was the EJ leak rate, while the secondary end point was the EJ stricture rate. RESULTS The mean ± SD age and body mass index were 59 ± 16 years and 28.1 ± 4.9 kg/m(2), respectively. Most patients were male (51 %), white (78 %), and former smokers (51 %). Over half (59 %) underwent neoadjuvant chemotherapy. A minimally invasive TG was performed in 70 % of patients. Signet ring was the most common tumor type (48 %), and most patients had midstage disease (59 %). The mean number of lymph nodes procured was 36 ± 16. Eighteen patients (49 %) experienced a complication, mostly minor. One patient (2.7 %) developed an EJ leak, while three patients (8 %) developed an EJ stricture. Median follow-up was 7 months (range 2-12 months). There was no operative or in-hospital mortality. DISCUSSION The use of urinary bladder matrix scaffolds may be helpful in decreasing the incidence of EJ anastomotic leak and/or stricture. A prospective phase II trial at our institution is currently under way.
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Affiliation(s)
- Cheguevara Afaneh
- Department of Surgery, Gastric and Mixed Tumor Service, Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
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Strong VE, Selby LV, Sovel M, Disa JJ, Hoskins W, Dematteo R, Scardino P, Jaques DP. Development and assessment of Memorial Sloan Kettering Cancer Center's Surgical Secondary Events grading system. Ann Surg Oncol 2014; 22:1061-7. [PMID: 25319579 DOI: 10.1245/s10434-014-4141-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studying surgical secondary events is an evolving effort with no current established system for database design, standard reporting, or definitions. Using the Clavien-Dindo classification as a guide, in 2001 we developed a Surgical Secondary Events database based on grade of event and required intervention to begin prospectively recording and analyzing all surgical secondary events (SSE). METHODS Events are prospectively entered into the database by attending surgeons, house staff, and research staff. In 2008 we performed a blinded external audit of 1,498 operations that were randomly selected to examine the quality and reliability of the data. RESULTS Of 4,284 operations, 1,498 were audited during the third quarter of 2008. Of these operations, 79 % (N = 1,180) did not have a secondary event while 21 % (N = 318) had an identified event; 91 % of operations (1,365) were correctly entered into the SSE database. Also 97 % (129 of 133) of missed secondary events were grades I and II. There were 3 grade III (2 %) and 1 grade IV (1 %) secondary event that were missed. There were no missed grade 5 secondary events. CONCLUSIONS Grade III-IV events are more accurately collected than grade I-II events. Robust and accurate secondary events data can be collected by clinicians and research staff, and these data can safely be used for quality improvement projects and research.
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Affiliation(s)
- Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA,
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Salih AEA, Bass GA, D’Cruz Y, Brennan RP, Smolarek S, Arumugasamy M, Walsh TN. Extending the reach of stapled anastomosis with a prepared OrVil™ device in laparoscopic oesophageal and gastric cancer surgery. Surg Endosc 2014; 29:961-71. [DOI: 10.1007/s00464-014-3768-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/25/2014] [Indexed: 12/29/2022]
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Cianchi F, Macrì G, Indennitate G, Mallardi B, Trallori G, Biagini MR, Badii B, Staderini F, Perigli G. Laparoscopic total gastrectomy using the transorally inserted anvil (OrVil™): a preliminary, single institution experience. SPRINGERPLUS 2014; 3:434. [PMID: 25152855 PMCID: PMC4141073 DOI: 10.1186/2193-1801-3-434] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 08/06/2014] [Indexed: 12/29/2022]
Abstract
Laparoscopic total gastrectomy (LTG) is not a commonly performed procedure due to the difficulty associated with surgical reconstruction. We present our preliminary results after intracorporeal circular stapling esophagojejunostomy using the newly developed transorally inserted anvil (OrVil™, Covidien, MA, USA). Between 2008 and June 2013, 51 patients underwent laparoscopic gastrectomy with D2 lymph node dissection for gastric cancer. A total of 12 patients underwent LTG: of these, 5 received an intracorporeal linear side-to-side esophagojejunal anastomosis and the remaining 7 underwent intracorporeal circular stapling esophagojejunostomy using the OrVil™ system. Short-term outcomes were compared between the two groups. There were no intraoperative complications or conversions to open surgery in any patients. The mean operative time was significantly shorter in the OrVil™ than in the side-to-side group (261.4 ± 12.0 vs 333.0 ± 15.0 minutes, respectively, p = 0.005). Postoperative fluorography revealed no anastomosis leakage or stenosis in either groups. All patients resumed an oral liquid diet on postoperative day 5 and the mean postoperative hospital stay was 9 days. Intracorporeal circular stapling esophagojejunostomy using the OrVil™ system is technically feasible and safe in LTG. This technique may be considered a simple and time-saving alternative to the side-to-side linear esophagojejunostomy.
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Affiliation(s)
- Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy ; Endocrine and Minimally Invasive Surgery, Azienda Ospedaliero-Universitaria Careggi, Center of Oncologic Minimally Invasive Surgery (COMIS), Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Giuseppe Macrì
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | | | | | - Giacomo Trallori
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Maria Rosa Biagini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Benedetta Badii
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Fabio Staderini
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Giuliano Perigli
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Xie JW, Huang CM, Zheng CH, Li P, Wang JB, Lin JX, Jun L. A safe anastomotic technique of using the transorally inserted anvil (OrVil) in Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy for proximal malignant tumors of the stomach. World J Surg Oncol 2013; 11:256. [PMID: 24094137 PMCID: PMC3850741 DOI: 10.1186/1477-7819-11-256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/19/2013] [Indexed: 12/11/2022] Open
Abstract
Background To explore the safety and feasibility of the transorally inserted anvil (OrVil™) in laparoscopy-assisted total gastrectomy for gastric cancer. Methods From December 2010 to June 2011, a total of 28 patients underwent laparoscopy-assisted total gastrectomy with a Roux-en-Y-esophagojejunostomy anastomosis with OrVil™. Perioperative treatments, intraoperative data, postoperative complications and hospital length of stay were evaluated. Results There were no conversions to the open gastrectomy. The mean operation time was 143 minutes and the mean blood loss was 70 ml. Patients resumed an oral liquid diet on postoperative days 4 to 5. Two patients (7%) who suffered postoperative aspiration pneumonia were cured by conservative treatment. The median hospital length of stay was 9.6 days (8 to 11 days), with no inhospital mortalities. The median follow-up time was 14.8 months (12 to 18 months), and postoperative endoscopic examination revealed no anastomosis stenosis in patients who had dysphagia. Conclusion The use of the OrVil™ is technically feasible and relatively safe for Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy.
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Affiliation(s)
- Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No 29 Xinquan Road, Fuzhou 350001, Fujian Province, China.
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