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Kameyama A, Yoshifuku S, Sasahara K, Otagiri N, Miyamoto M, Nishida Y, Tauchi K. Risk factors associating with delayed gastric emptying after laparoscopic distal gastrectomy. Asian J Endosc Surg 2023; 16:35-40. [PMID: 36594160 DOI: 10.1111/ases.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE The aim of this study was to investigate the incidence of delayed gastric emptying among the patients receiving laparoscopic distal gastrectomy, and to explore their clinical features and risk factors. METHODS Clinical data were collected for 223 patients who underwent laparoscopic distal gastrectomy for gastric cancer. We retrospectively evaluated the clinicopathological features and analyzed the incidence of delayed gastric emptying among 223 patients. Delayed gastric emptying was diagnosed by patient's symptoms and the plane radiograph with an air fluid level and dilation of the remnant stomach. RESULTS Delayed gastric emptying was found in five (2.2%) of the 223 patients. By univariate logistic regression analysis, greater American Society of Anesthesiologists Physical Status (ASA-PS) and older age were significantly related to occurrence of delayed gastric emptying. By multivariate logistic regression analysis, older age was independently significantly related to incident delayed gastric emptying. The area under the curve (AUC) ((95% CI) of the receiver operating characteristic (ROC) was 0.842 (0.561-0.957). The best cutoff for discriminating patients with and without delayed gastric emptying was 80 years (sensitivity 80% and specificity 83%). CONCLUSION Our study found the occurrence of delayed gastric emptying is possibly correlated with age. Therefore, careful perioperative observation in elderly patients may possibly be important for possible development of delayed gastric emptying after laparoscopic distal gastrectomy.
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Affiliation(s)
- Akira Kameyama
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
| | - Seiziro Yoshifuku
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
| | - Kotaro Sasahara
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
| | - Noriaki Otagiri
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
| | - Masatake Miyamoto
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
| | - Yasunori Nishida
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
| | - Katsunori Tauchi
- Department of Gastrointestinal Surgery, Aizawa hospital, Nagano, Japan
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Systemic steroid application for treatment of edematous anastomotic stenosis following delta-shaped anastomosis in laparoscopic distal gastrectomy: a case report. BMC Surg 2020; 20:163. [PMID: 32698798 PMCID: PMC7376961 DOI: 10.1186/s12893-020-00827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/17/2020] [Indexed: 11/15/2022] Open
Abstract
Background Delta-shaped anastomosis is a common method of intracorporeal gastroduodenostomy in totally laparoscopic distal gastrectomy. One common postoperative complication of this procedure is anastomotic stenosis, and endoscopic balloon dilatation is a major remedy for such complications. Other treatment strategies are necessary to manage unsuccessful endoscopic balloon dilatation. Case presentation We present a case where systemic steroid treatment was applied in sustained anastomotic stenosis after endoscopic balloon dilatation. We performed delta-shaped anastomosis in laparoscopic distal gastrectomy to treat early-stage gastric cancer in a patient. The patient experienced abdominal pain post-surgery; subsequent investigation revealed edematous anastomotic stenosis. The stenosis sustained even after endoscopic balloon dilatation and local steroid injection. Consequently, we applied systemic steroid treatment. Conclusion Systemic steroid treatment improved the stenosis and no recurrence was observed. These results suggest that systemic steroid application could be useful to treat anastomotic stenosis.
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Kim DH, Yun HY, Song YJ, Ryu DH, Han HS, Han JH, Kim KB, Yoon SM, Youn SJ. Clinical features of gastric emptying after distal gastrectomy. Ann Surg Treat Res 2017; 93:310-315. [PMID: 29250510 PMCID: PMC5729125 DOI: 10.4174/astr.2017.93.6.310] [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] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/01/2017] [Accepted: 05/19/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose Gastric emptying may influence the quality of life of patients who undergo distal gastrectomy. Little is known, however, about gastric emptying after distal gastrectomy. The aim of our study was to investigate gastric emptying patterns after distal gastrectomy. Methods This gastric-emptying study investigated patients who underwent distal gastrectomy in the 6 months or more before May 2008 to July 2013 at Chungbuk National University Hospital with a study sample of 205 patients. We analyzed patterns of gastric emptying. Results Delayed gastric emptying was found in 109 of the 205 patients (53.2%). Food stasis was more frequent in a group with delayed gastric emptying. In multivariate analysis, risk factors for gastroparesis were laparoscopic operation (hazard ratio [HR], 2.731; P = 0.008) and duration of less than 24 months after distal gastrectomy (HR, 2.795; P = 0.001). Delayed gastric emptying tended to decrease with duration of the postoperative period. Conclusion Delayed gastric emptying is common in distal gastrectomy, and is related to laparoscopic operation and duration of the postoperative period. Food stasis was more frequent in a group with delayed gastric emptying.
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Affiliation(s)
- Dae Hoon Kim
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Hyo Yung Yun
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Young-Jin Song
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea
| | - Hye-Suk Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Joung-Ho Han
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ki Bae Kim
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Soon Man Yoon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sei Jin Youn
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.,Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
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Li MZ, Deng L, Wang JJ, Xiao LB, Wu WH, Yang SB, Li WF. Surgical outcomes and prognostic factors of T4 gastric cancer patients without distant metastasis. PLoS One 2014; 9:e107061. [PMID: 25211331 PMCID: PMC4161379 DOI: 10.1371/journal.pone.0107061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/05/2014] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate surgical outcomes and prognostic factors for T4 gastric cancer treated with curative resection. Methods Between January 1994 and December 2008, 94 patients diagnosed with histological T4 gastric carcinoma and treated with curative resection were recruited. Patient characteristics, surgical complications, survival, and prognostic factors were analyzed. Results Postoperative morbidity and mortality were 18.1% and 2.1%, respectively. Multivariate analysis indicated lymph node metastasis (hazard ratio, 2.496; 95% confidence interval, 1.218–5.115; p = 0.012) was independent prognostic factor. Conclusions For patients with T4 gastric cancer, lymph node metastasis was associated with poorer survival. Neoadjuvant chemotherapy or aggressive adjuvant chemotherapy after radical resection was strongly recommended for these patients.
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Affiliation(s)
- Ming-zhe Li
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Deng
- Department of General Surgery I, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-jing Wang
- Department of laboratory, Hexian Memory Hospital of Panyu District, Guangzhou, China
| | - Long-bin Xiao
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail:
| | - Wen-hui Wu
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shi-bin Yang
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen-feng Li
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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