ObjectiveTo explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).MethodThe clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.ResultsTLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.ConclusionFrom preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.
Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ2=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ2=5.894, P < 0.05;χ2=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.
世界首例成功的全胃切除及消化道重建术（结肠前食管空肠端侧吻合术）1897年由德国人Schlatter完成； 随后Briigham对重建的术式做出了最早的探索，这一食管十二指肠吻合术也是最早的保留十二指肠食物通道功能的术式（Billroth Ⅰ）； 1903年Moynihan提出应加行空肠输入-输出袢之间的侧侧吻合（Braun吻合）； 1947年Orr提出的Roux-en-Y术式是最经典的不保留十二指肠食物通道功能的术式，以它为基础的术式（Billroth Ⅱ）在全胃切除术后的消化道重建中占有主要地位［1］。......
Objective To evaluate whether jejunal interposition pouch (JIP) reconstruction is an ideal procedure of digestive tract reconstruction after total gastrectomy. Methods Ninetyfour patients after total gastrectomy had randomly divided into two groups, JIP group 42 cases and RouxenY pouch (RYP) group 52 cases. The gastrointestinal function improvement in body weight and nutritional parameters (serum albumin, hemoglobin level, and serum protein) were compared 1 year after surgery for the two groups. Results The nutritional condition of JIP group and RYP group after operation had improved (P＜0.01); and the condition of JIP group with fewer symptom problems demonstrated much more better than standard RYP group （P＜0.01）. Conclusion JIP that could obtain partly compensatory function after total gastrectomy is an ideal reconstruction.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
ObjectiveTo evaluate the effect of glutamineenhanced enteral nutritional support on elder patients after total gastrectomy. MethodsA total of eightyfour cases of elder patients receiving total gastrectomy were included in this study from February 2008 to August 2010. The patients were randomly divided into three groups: glutamineenhanced enteral nutrition (Gln) group, enteral nutrition (EN) group and parenteral nutrition (PN) group. The complications and hospital stay after operation were compared, and the levels of serum total protein, albumin, proalbumin， and transferrin of patients were measured before operation, on 2 d and 10 d after operation, respectively. Furthermore, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio， and the levels of serum IgM and IgG of patients in peripheral blood before and after operation were detected. ResultsNutritional therapy was successfully performed in patients of three groups. The anal exhaust time and hospital stay after operation of patients in Gln group and EN group were significantly lower than those in PN group (Plt;0.05). The difference of postoperative complications and digestive tract symptoms of patients in three groups was not obvious (Plt;0.05). Anastomotic fistula occurred in one patient of PN group on 6 d after operation and was cured by conservative treatment for 54 d. The difference of total protein, albumin, proalbumin, and transferrin levels of patients in three groups before operation was not significant (Pgt;0.05), and these indexes fell dramatically on 2 d after operation and lower than before operation (Plt;0.05), although the intergroup difference was not statistically significant (Pgt;0.05). On 10 d after operation, all indexes recovered in different extent, while those data in Gln group and EN group were significantly higher than those on 2 d after operation (Plt;0.05). The levels of total protein, albumin, and proalbumin of patients in Gln group and EN group were markedly higher than those in PN group (Plt;0.05), although there was no difference between the former groups (Pgt;0.05). The difference of several immunological parameters of patients in three groups before operation was not significant (Pgt;0.05). On 10 d after operation, the percentage of CD4 and CD8 T cells, CD4/CD8 ratio, and the levels of serum IgM and IgG of patients in Gln group returned and even exceeded the preoperative results, which were significantly higher than those in EN group and PN group other than IgM (Plt;0.05). The postoperative results of all parameters except IgG in EN group were significantly lower than preoperative results in patients of EN group and PN group (Plt;0.05). ConclusionsIt is safe and feasible to elder patients who had received total gastrectomy and perioperative glutamine-enhanced nutritional support, which can improve nutrition and immune status, promote the recovery and reduce the duration of hospital stay, and nutritiional support after total gastrectomy is one of the optimal choices for these patients.
Objective To explore the optimal technique for digestive tract reconstruction of proximal gastrectomy. Methods Fifty-nine patients who underwent proximal subtotal gastrectomy during June 2004 and January 2007 were analyzed retrospectively. All patients were divided into 2 groups according to the styles of reconstruction: one group with gastroesophagostomy (GE group) and the other with accommodation double tract digestive reconstruction of jejunal interposition (GIE group). The reconstruction of GIE group was to interposite a continuous 35 cm jejunum between the gastric stump and the oesophagus, which detail had been reported in our previous literature. The quality of life in 2 groups were evaluated and compared. Results No patient died and there was no anastomotic leakage, dumping syndrome and moderate or severe anemia occurred during perioperative period. There was no significant difference of the following indexes of nutrition between 2 groups 1 month and 6 months after operation: the value of weight, RBC, Hb, Alb, PNI and the indexes versus the preoperative ones (Pgt;0.05), for the exception of the indexes of RBC (P=0.006), Hb (P=0.001) in 1 month after operation versus the preoperative ones. The abdominal and the reflux esophagitis symptoms in GIE group were milder than those in GE group (Plt;0.001). The Visick scoring: most of the GIE group were gradeⅡ (74.2%), and grade Ⅲ (64.3%) in the GE group. There was no delay of the first time of adjuvant chemotherapy in GIE group (Pgt;0.05), and the surgical time was (0.35±0.13) h more than that of GE group (P=0.01). Conclusion The accommodation double tract digestive reconstruction of jejunal interposition for proximal subtotal gastrectomy may be safe and feasible by decreasing residual cancer cells and improving the quality of life of patients with proximal gastric carcinoma who underwent such surgical procedure.
Objective To investigate the influence on the postoperative recovery for giving either total parenteral nutrition （TPN） or early enteral nutrition (EEN) to patients with gastric cancer after total gastrectomy. Methods Eighty-six patients with gastric cancer undergone total gastrectomy were divided into TPN group (n=31) and EEN group (n=55). Patients in TPN group received TPN support via vena cava (internal jugular vein or subclavian vein), while patients in EEN group received early feeding through the naso-intestinal tube, which was placed during operation, and volume of enteral nutrition (fresubin) was increased daily, full enteral nutrition was expected on day 3-5. Nutrition status after operation, postoperative plasma albumin (Alb), the time of passing gas or stool, the time of oral intake, hospital stay and any postoperative complications were recorded and analyzed. Results There were no significant differences between two groups (Pgt;0.05) in postoperative plasma Alb level, the time of passing gas or stool, postoperative complications rate or hospital stay. However, in the TPN group, the time of oral intake was shorter than that in EEN group (P=0.004). Conclusions Both TPN and EEN are the suitable nutritional methods for patients with gastric cancer after total gastrectomy, and with no detectable difference. For patients with high risk, such as severe malnutrition, naso-intestinal tube should be placed for EEN.
Objective To investigate the differences of postoperative quality of life （QOL） between proximal gas-trectomy （PG） and total gastrectomy （TG） in patients with adenocarcinoma of esophagogastric junction （AEG）. Methods Eighty five patients with AEG （Siewert type Ⅱ or Ⅲ） who were underwent PG or TG surgery between Jan. 2011 andMar. 2012 at West China Hospital of Sichuan University were enrolled， to measure the QOL by using the Chineseversion of quality of life questionnaire core-30 （QLQ-C30） and the site-specific module for gastric cancer （QLQ-STO22）which were drawed up by the European Organization for Research and Treatment of Cancer （EORTC） in 12 months afteroperation. Results There were no any difference of clinicopathological features between patients in 2 groups （P＞0.05），such as age， gender， and so on. The scores of eating restriction， diarrhea， and dyspnea in PG group were lower than those of TG group （P＜0.05）， but scores of reflux and taste change were higher （P＜0.05）， no other significant differ-ence was found between the patients of 2 groups （P＞0.05）. Conclusion Both of PG＋gastric tube reconstruction and TG＋Roux-en-Y anastomosis in treatment of patients with Siewert type Ⅱ or Ⅲ AEG may lead to complications， but patients who underwent former surgery have better situation in eating restriction， diarrhea， and dyspnea， and patients who underwent later surgery have better situation in reflux and taste change.