Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis

Different Methods of Minimally Invasive Esophagojejunostomy After Total Gastrectomy for Gastric Cancer: Outcomes from Two Experienced Centers

BACKGROUND

Esophagojejunostomy after minimally invasive total gastrectomy (MITG) for gastric cancer (GC) is technically challenging. Failure of the esophagojejunal anastomosis can lead to significant morbidity, leading to short- and long-term quality of life (QoL) impairment or mortality. The optimal reconstruction method following MITG remains controversial. We evaluated outcomes of minimally invasive esophagojejunostomy after laparoscopic or robotic total gastrectomies.

METHODS

We retrospectively reviewed MITG patients between 2015 and 2020 at two high-volume centers in China and the United States. Eligible patients were divided into groups by different reconstruction methods. We compared clinicopathologic characteristics, postoperative outcomes, including complication rates, overall survival rate (OS), disease-free survival rate (DFS), and patient-reported QoL.

RESULTS

GC patients (n = 105) were divided into intracorporeal esophagojejunostomy (IEJ, n = 60) and extracorporeal esophagojejunostomy (EEJ, n = 45) groups. EEJ had higher incidence of wound infection (8.3% vs 13.3%, P = 0.044) and pneumonia (21.7% vs 40.0%, P = 0.042) than IEJ. The linear stapler (LS) group was inferior to the circular stapler (CS) group in reflux [50.0 (11.1-77.8) vs 44.4 (0.0-66.7), P = 0.041] and diarrhea [33.3 (0.0-66.7) vs 0.0 (0.0-66.7), P = 0.045] while LS was better than CS for dysphagia [22.2 (0.0-33.3) vs 11.1 (0.0-33.3), P = 0.049] and eating restrictions [33.3 (16.7-58.3) vs 41.7 (16.7-66.7), P = 0.029] at 1 year. OS and DFS did not differ significantly between LS and CS.

CONCLUSIONS

IEJ anastomosis generated better results than EEJ. LS was associated with a better patient eating experience, but more diarrhea and reflux compared with CS. Clinical and patient-reported outcomes show the superiority of IEJ with the LS reconstruction method in MITG for GC.

Effect of Double-Channel Anastomosis and Esophagojejunal Anastomosis on Postoperative Recovery and Complications of Laparoscopic D2 Radical Gastrectomy for Gastric Cancer

The aim of this study was to investigate the effects of double-channel anastomosis versus esophagojejunostomy on postoperative recovery and complications after laparoscopic D2 radical gastrectomy for early proximal gastric cancer. The cases were collected from 100 patients with early proximal gastric cancer admitted to our hospital from January 2017 to January 2021. According to different surgical methods, they were divided into control group (total gastrectomy + esophagojejunal anastomosis) and experimental group (D2 radical resection + double-channel anastomosis). The two groups were compared in terms of clinical outcomes (operative time, intraoperative blood loss, number of lymph nodes dissected, digestive tract anastomosis time, postoperative exhaust, and hospitalization days), postoperative complications, and nutritional status; the expression of T lymphocyte subsets in peripheral blood of the two groups was detected to reflect the recovery of immune ability. There was no significant difference between the observation group and the control group in clinical operation effect indexes (P < 0.05). The incidence of complications of dumping syndrome and reflux esophagitis in the observation group was significantly lower than that in the control group (P < 0.05). In terms of postoperative nutritional status, the ratio of plasma albumin level and body weight restored to operation at 12 and 24 weeks after operation in the observation group was significantly higher than that in the control group (P < 0.05). 3 months after the operation, the levels of CD3 +, CD4 + cell subsets, and CD4+/CD8+ index reflecting the recovery of immune ability in the observation group were significantly higher than those in the observation group (P < 0.05). The application of double-channel anastomosis in laparoscopic D2 radical gastrectomy for early proximal gastric cancer has a better effect on reducing complications and promoting postoperative recovery, which is of great application value.

Clinical Effect Analysis of Laparoscopic Surgery for Gastric Tumor under Data Mining

This paper mainly analyzes the feasibility of laparoscopic local gastrectomy for the treatment of benign gastric tumors, evaluating its curative effect, and the use of traditional Chinese medicine (TCM) such as Hedyotis diffusa, Radix Pseudostellariae, yi, Pinellia ternata, Ophiopogon japonicus, wood fragrance, Perilla, Scutellaria baicalensis, Yuzhu, hawthorn, Artemisia annua, chicken yellow film, nail, and turtle, and clinical symptoms of statistical analysis of data mining. A total of 86 patients with gastric benign tumor were selected as the research object and were divided into observation group and control group with 43 cases in each by the random number table method. The control group received radical gastrectomy for benign tumor under laparoscopy, while the observation group received local gastrectomy under laparoscopy. Perioperative indexes such as operative time, intraoperative blood loss, and length of hospital stay were recorded in the two groups. Serum C-reactive protein (CRP) and carcinoembryonic antigen (CEA) levels were analyzed by enzyme-linked immunosorbent assay (ELISA), and the incidence of complications was compared. Based on the clinical analysis of the drug used, the results of association significance were selected, and the top ten results were selected in order of confidence and grouped according to clinical symptoms, respectively, as follows: (1) abdominal distension: Hedyotis diffusa, Radix Pseudostellariae, Poria cocos, Huckleberry, and Coix seed; (2) dry mouth: Poria cocos, Radix Radix Pseudostellariae, Coix seed, Pinellia tuber, and Radix Ophiopogonis. The results showed that the minimum operation time in the observation group was 159.7 ± 13.07 min and the maximum was 172.57 ± 2.47 min, which was lower than that in the control group (the minimum was 172.46 ± 12.45 min and the maximum was 186.49 ± 24.32 min). The length of hospital stay (6.51 ± 1.29 days) was lower than that in the control group (7.56 ± 1.42 days) (P < 0.05). The CEA and CRP levels decreased significantly in both groups after treatment (P < 0.05). However, the observation group's CEA was (4.21 ± 1.05) mg/L and CRP was (8.46 ± 1.25) μg/L. In the control group, CEA was (4.18 ± 1.02) mg/L and CRP was (8.39 ± 1.24) μg/L. There were no significant differences (P < 0.05). The incidence of complications in the observed group was 4.7% lower than 7.0% in the control group (P < 0.05). Therefore, laparoscopic local gastric resection for benign gastric tumors can effectively reduce the incidence of CEA and CRP level and complications and improve the perioperative indicators, which is worth popularizing in clinical practice.

The effects of uncut Roux-en-Y anastomosis on laparoscopic radical gastrectomy patients' postoperative complications and quality of life

OBJECTIVES

This study discusses and analyzes the effects of uncut Roux-en-Y anastomosis on the postoperative complications and quality of life of gastric cancer patients after they undergo laparoscopic total gastrectomies.

METHODS

86 patients admitted to our hospital for laparoscopic digestive tract reconstruction after distal gastrectomies were recruited as the study cohort and divided into group A (n=41) or group B (n=45) on the basis of the different digestive tract reconstruction surgery each patient underwent. The group-A patients underwent traditional Roux-en-Y anastomosis, and the group-B patients underwent uncut Roux-en-Y anastomosis. The operation outcomes, the early and late postoperative complications, the decline in the postoperative nutrition status, and the changes in the postoperative quality of life scores were compared between the two groups.

RESULTS

The intraoperative anastomosis times and the blood losses, the postoperative ventilation, the liquid food intake times, and the hospitalization durations in group B were lower than they were in group A (P<0.05). The incidences of early and late postoperative complications in group A was significantly higher than they were in group B (P<0.05). The decrease of the TP, ALB, and Hb levels in group B was dramatically lower than it was in group A at 6 months after the surgeries (P<0.05), and no significant difference in the TP, ALB, or Hb levels was observed between the two groups at 12 months after the surgeries (P>0.05). The QOL scores in the two groups of patients were increased at 6 and 12 months after the surgeries compared with 1 month after the surgeries (P<0.05). The QOL scores in group B were notably higher than they were in group A at 6 and 12 months after the surgeries (P<0.05).

CONCLUSION

Uncut Roux-en-Y anastomosis after laparoscopic total gastrectomy is simple to carry out. The method can promote patients' early postoperative recovery, reduce their early and late complications, and maintain their postoperative nutritional status, thus improving their postoperative quality of life, so it is worthy of clinical promotion.

Comparison of hand-assisted laparoscopic radical gastrectomy and laparoscopic-assisted radical gastrectomy: A systematic review and meta-analysis

BACKGROUND

Gastrectomy is the optimal treatment for gastric cancer. Laparoscopic-assisted gastrectomy (LAG) has been extensively employed, while hand-assisted laparoscopic gastrectomy (HALG), which is similar to LAG, remains controversial. Although HALG is popular in China, some surgeons do not accept it as a minimal-access technique. 

AIM

To assess the safety and practicability of HALG by comparing the short-term outcomes of HALG and LAG.

METHODS

The electronic databases of EMBASE, PubMed, China National Knowledge Infrastructure, and Cochrane Library were thoroughly searched, and randomized controlled trials (RCTs) comparing HALG and LAG were included. The study results, including surgery time, blood loss, retrieved lymphatic nodes, incision length, time to first flatus, hospitalization duration, and all postsurgical complications, were compared between the two groups.

RESULTS

Five RCTs, which included 302 cases with HALG and 298 cases with LAG, were considered eligible for inclusion. Meta-analysis showed that HALG significantly reduced surgery time (P < 0.01), hospital duration (P < 0.01), and overall postsurgical complications (P < 0.01). Additionally, HALG significantly increased the number of retrieved lymphatic nodes (P = 0.01) and incision length (P < 0.01) compared with LAG. The blood loss and time to first flatus were similar between the two groups (P > 0.05).

CONCLUSION

Compared with LAG, HALG is a simpler and safer technique. Additionally, HALG should be used as a minimal-access technique, especially in technologically undeveloped areas.

Open versus arthroscopic ankle arthrodesis: a systematic review and meta-analysis

Background

Osteoarthritis (OA) is a growing health concern that affects approximately 27 million people in the USA and is associated with a $185 billion annual cost burden. Choosing between open surgery and arthroscopic arthrodesis for ankle arthritis is still controversial. This study compared arthroscopic arthrodesis and open surgery by performing a systematic review and meta-analysis.

Methods

For the systematic review, a literature search was conducted in 4 English databases (PubMed, Embase, Medline and the Cochrane Library) from inception to February 2020. Three prospective cohort studies and 7 retrospective cohort studies, enrolling a total of 507 patients with ankle arthritis, were included.

Results

For fusion rate, the pooled data showed a significantly higher rate of fusion during arthroscopic arthrodesis compared with open surgery (odds ratio 0.25, 95% CI 0.11 to 0.57, p = 0.0010). Regarding estimated blood loss, the pooled data showed significantly less blood loss during arthroscopic arthrodesis compared with open surgery (WMD 52.04, 95% CI 14.14 to 89.94, p = 0.007). For tourniquet time, the pooled data showed a shorter tourniquet time during arthroscopic arthrodesis compared with open surgery (WMD 22.68, 95% CI 1.92 to 43.43, p = 0.03). For length of hospital stay, the pooled data showed less hospitalisation time for patients undergoing arthroscopic arthrodesis compared with open surgery (WMD 1.62, 95% CI 0.97 to 2.26, p < 0.00001). The pooled data showed better recovery for the patients who underwent arthroscopic arthrodesis compared with open surgery at 1 year (WMD 14.73, 95% CI 6.66 to 22.80, p = 0.0003).

Conclusion

In conclusion, arthroscopic arthrodesis was associated with a higher fusion rate, smaller estimated blood loss, shorter tourniquet time, and shorter length of hospitalisation than open surgery.