ObjectiveTo investigate the ideal digestive tract reconstruction method for radical distal gastrectomy (DG). MethodsClinical and follow-up data of 862 patients with gastric cancer who underwent DG in Xijing Hospital of Digestive Diseases of The Fourth Military Medical University from January 2010 to January 2013 were analyzed retrospectively. According to reconstruction methods, patients were divided into three groups:Billroth Ⅰ group (B-Ⅰgroup), Billroth Ⅱ (B-Ⅱ)+Braun group (B-Ⅱ+Braun group), and Roux-en-Y group. In order to reduce the difference of clinicopa-thological characteristics, Gmatch method was used to select patients basing on gender, age (±5 years), tumor size (±1 cm), pT staging, and pN staging. The perioperative data, recent (30 days after surgery) complications, gastroscopic results over one year, and postoperative survival rate were compared respectively among the 3 groups. Results① Perioperative indexes. The operative time, postoperative hospitalization, and semi liquid diet time were significantly different among 3 groups (P < 0.050). As compared with B-Ⅱ+Braun group and Roux-en-Y group, B-Ⅰ group had a significantly shorter operative time (P < 0.012 5), and there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group (P > 0.012 5). As compared with B-Ⅱ+Braun group, B-Ⅰ group had a significantly shorter semi liquid diet time (P < 0.012 5), but there was no significant difference between B-Ⅱ+Braun group and Roux-en-Y group, as well as Roux-en-Y group and B-Ⅰ group (P > 0.012 5). As compared with B-Ⅰ group and B-Ⅱ+Braun group, Roux-en-Y group had a significantly longer postoperative hospitalization (P < 0.012 5), and there was no significant difference between B-Ⅰ group and B-Ⅱ+ Braun group (P > 0.012 5). ② There was no significant difference in recent complications between Roux-en-Y group (12.5%, 4/32), B-Ⅱ+Braun (6.2%, 2/32), and B-Ⅰ group (3.1%, 1/32), P=0.495. ③ Results of endoscopic examination over 1 year after radical DG showed that there was significant difference among 3 groups (P < 0.050). Compared with B-Ⅰ group and B-Ⅱ+Braun group, the rates of reflux gastritis, bile reflux, and reflux esophagitis of Roux-en-Y group were all lower (P < 0.012 5), but there was no significant difference between B-Ⅰ group and B-Ⅱ+Braun group (P > 0.012 5).④ The 3-year survival rates of Roux-en-Y group, B-Ⅱ+Braun group, and B-Ⅰ group were 70.0% (21/30), 73.3% (22/30), and 75.0% (24/32) respectively, and there was no significant difference in the survival situation (P=0.911). ConclusionsThe effect of Rouxen-Y anastomosis on resisting gastrointestinal reflux is remarkable. B-Ⅰanastomosis has the advantages of more simple operation, faster recovery, and more similar to the physiological structure. Thus, B-Ⅰ anastomosis and Roux-en-Y anastomosis are recommended for digestive tract reconstruction in DG.
ObjectiveTo investigate the feasibility of totally laparoscopic distal gastrectomy (TLDG) based on delta-shaped gastroduodenostomy in the treatment of gastric cancer. MethodsNinety patients with gastric cancer who treated in our hospital from December 2013 to December 2015 were retrospectively analyzed. Forty-five patients with gastric cancer received delta-shaped gastroduodenostomy by using laparoscopic linear stapler after they were treated with TLDG and D2 lymphadenectomy (TLDG group), while 45 patients with gastric cancer received laparoscopic assisted distal gastrectomy (LADG) and D2 lymphadenectomy (LADG group). The operative time, digestive tract reconstruction time, blood loss, number of dissected lymph nodes, length of proximal and distal margin to the cancer, time of the first flatus, recovery time of drinking water, time of resuming semi-fluid diet, postoperative hospital stay, and complications during follow-up period were observed and evaluated. Results① Intraoperative findings. The operative time, digestive tract reconstruction time, and length of distal margin to the cancer of TLDG group were significantly longer than those corresponding index of LADG group (P < 0.050), but the blood loss was significantly less than that of LADG group (P < 0.050). There was no significant difference between two groups in proximal margin to the cancer and number of dissected lymph nodes (P > 0.050). ② Postoperative findings. There was no significant difference between two groups in time of the first flatus, recovery time of drinking water, time of resuming semi-fluid diet, postoperative hospital stay, and incidence of complication (P > 0.050). All patients were followed for 6-16 months (median with 10 months), and there was no one suffered from recurrence, anastomotic stricture, and anastomotic obstruction. ConclusionThe TLDG based on delta-shaped gastroduodenostomy in the treatment of gastric cancer was feasible and safe, and it will be an ideal method for digestive tract reconstruction in patients with gastric cancer, so it is worthy to clinical application.