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Published in: Indian Journal of Surgery 2/2023

10-06-2022 | Gastrectomy | Original Article

Effect of π-shaped Esophagojejunal Anastomosis in Laparoscopic Total Gastrectomy

Authors: Kai Xu, Jiadi Xing, Maoxing Liu, Ming Cui, Chenghai Zhang, Hong Yang, Zhendan Yao, Nan Zhang, Fei Tan, Pin Gao, Xiangqian Su

Published in: Indian Journal of Surgery | Issue 2/2023

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Abstract

This study aimed to discuss the safety and feasibility of applying π-shaped esophagojejunal anastomosis in laparoscopic total gastrectomy (LTG). Case series analysis was utilized, cross-sectional method was used, and clinicopathological data from63 gastric cancer patients were gathered. Of the enrolled patients, 43 underwent laparoscopic total gastrectomy, dissociation of the esophagus and stomach, lymph node dissection and π-shaped anastomosis to complete laparoscopic reconstruction of the digestive tract. The other 20 patients underwent traditional open total gastrectomy (OTG). According to the unified statistical method, we calculated the ASA score results. In the case of laparoscopic total gastrectomy, π-shaped esophagojejunal anastomosis was successful. There was a significant difference in various preoperative physiological indexes, like tumor stage between the two groups. The average operative time of the laparoscopic total gastrectomy group was higher than that of the open total gastrectomy group, while the average intraoperative hemorrhage and postoperative recovery time were less than those of the open total gastrectomy group. The findings suggested that the application of π-shaped esophagojejunal anastomosis in laparoscopic total gastrectomy is safe and feasible based on the comparison of the short-term and long-term effects of the two groups of patients.
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Literature
1.
go back to reference Kim HH, Hyung WJ, Cho GS et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251(3):417–420CrossRefPubMed Kim HH, Hyung WJ, Cho GS et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251(3):417–420CrossRefPubMed
2.
go back to reference Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMed Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W et al (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report-a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg 251:417–420CrossRefPubMed
3.
go back to reference Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M et al (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRefPubMed Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M et al (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRefPubMed
4.
go back to reference Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ et al (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 32:627–633CrossRefPubMed Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ et al (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 32:627–633CrossRefPubMed
5.
go back to reference Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K et al (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741CrossRefPubMed Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K et al (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741CrossRefPubMed
6.
go back to reference Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW et al (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: shortterm outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRefPubMed Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW et al (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: shortterm outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRefPubMed
7.
go back to reference Zhang YX, Wu YJ, Lu GW et al (2015) Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer. World J Surg Oncol 13:116CrossRefPubMedPubMedCentral Zhang YX, Wu YJ, Lu GW et al (2015) Systematic review and meta-analysis of totally laparoscopic versus laparoscopic assisted distal gastrectomy for gastric cancer. World J Surg Oncol 13:116CrossRefPubMedPubMedCentral
8.
go back to reference Kwon IG, Son YG, Ryu SW (2016) Novel Intraeorporeal Esophagojejunostomy Using Linear Staplers During Laparoseopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique. J Am Coll Surg 223(3):e25–e29CrossRefPubMed Kwon IG, Son YG, Ryu SW (2016) Novel Intraeorporeal Esophagojejunostomy Using Linear Staplers During Laparoseopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique. J Am Coll Surg 223(3):e25–e29CrossRefPubMed
9.
go back to reference Yang HK, Suh YS, Lee HJ (2013) Minimally invasive approaches for gastric cancer Korean experience. J Surg Oncol 107(3):277–281CrossRefPubMed Yang HK, Suh YS, Lee HJ (2013) Minimally invasive approaches for gastric cancer Korean experience. J Surg Oncol 107(3):277–281CrossRefPubMed
10.
go back to reference Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ et al (2018) A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer. 22(1):214–222CrossRefPubMed Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ et al (2018) A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer. 22(1):214–222CrossRefPubMed
11.
go back to reference Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T et al (2015) Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 38(2):102–112CrossRefPubMed Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T et al (2015) Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 38(2):102–112CrossRefPubMed
12.
go back to reference Okabe H, Tsunoda S, Tanaka E, Hisamori S, Kawada H, Sakai Y (2015) Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes. Surg Today 45(5):549–558CrossRefPubMed Okabe H, Tsunoda S, Tanaka E, Hisamori S, Kawada H, Sakai Y (2015) Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes. Surg Today 45(5):549–558CrossRefPubMed
13.
go back to reference Obama K, Sakai Y (2016) Current status of robotic gastrectomy for gastric cancer. Surg Today 46(5):528–534CrossRefPubMed Obama K, Sakai Y (2016) Current status of robotic gastrectomy for gastric cancer. Surg Today 46(5):528–534CrossRefPubMed
14.
go back to reference Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC et al (2012) Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 16(7):1303–1310CrossRefPubMed Huang KH, Lan YT, Fang WL, Chen JH, Lo SS, Hsieh MC et al (2012) Initial experience of robotic gastrectomy and comparison with open and laparoscopic gastrectomy for gastric cancer. J Gastrointest Surg 16(7):1303–1310CrossRefPubMed
15.
go back to reference Kim MC, Heo GU, Jung GJ (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24(3):610–615CrossRefPubMed Kim MC, Heo GU, Jung GJ (2010) Robotic gastrectomy for gastric cancer: surgical techniques and clinical merits. Surg Endosc 24(3):610–615CrossRefPubMed
16.
go back to reference Yoon HM, Kim YW, Lee JH, Ryu KW, Eom BW, Park JY et al (2012) Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc 26(5):1377–1381CrossRefPubMed Yoon HM, Kim YW, Lee JH, Ryu KW, Eom BW, Park JY et al (2012) Robot-assisted total gastrectomy is comparable with laparoscopically assisted total gastrectomy for early gastric cancer. Surg Endosc 26(5):1377–1381CrossRefPubMed
17.
go back to reference Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131(1):S306–S311CrossRefPubMed Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131(1):S306–S311CrossRefPubMed
18.
go back to reference Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237CrossRefPubMedPubMedCentral Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A et al (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241(2):232–237CrossRefPubMedPubMedCentral
19.
go back to reference Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH et al (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22(2):436–442CrossRefPubMed Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH et al (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22(2):436–442CrossRefPubMed
20.
go back to reference Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH et al (2011) Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 146(9):1086–1092CrossRefPubMed Woo Y, Hyung WJ, Pak KH, Inaba K, Obama K, Choi SH et al (2011) Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers. Arch Surg 146(9):1086–1092CrossRefPubMed
21.
go back to reference Kwon IG, Son YG, Ryu SW (2016) Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: π-shaped esophagojejunostomy, 3-in-1 technique. J Am Coll Surg 223(3):e25–e29CrossRefPubMed Kwon IG, Son YG, Ryu SW (2016) Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: π-shaped esophagojejunostomy, 3-in-1 technique. J Am Coll Surg 223(3):e25–e29CrossRefPubMed
22.
go back to reference Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247(6):962–967CrossRefPubMed Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K (2008) A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gastrectomy. Ann Surg 247(6):962–967CrossRefPubMed
23.
go back to reference Lee HH, Hur H, Jung H, Jeon HM, Park CH, Song KY (2011) Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg 201(6):841–845CrossRefPubMed Lee HH, Hur H, Jung H, Jeon HM, Park CH, Song KY (2011) Robot-assisted distal gastrectomy for gastric cancer: initial experience. Am J Surg 201(6):841–845CrossRefPubMed
24.
go back to reference Hyun MH, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH et al (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20(4):1258–1265CrossRefPubMed Hyun MH, Lee CH, Kwon YJ, Cho SI, Jang YJ, Kim DH et al (2013) Robot versus laparoscopic gastrectomy for cancer by an experienced surgeon: comparisons of surgery, complications, and surgical stress. Ann Surg Oncol 20(4):1258–1265CrossRefPubMed
25.
go back to reference Sano T, Aiko T (2011) New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 14(2):97–100CrossRefPubMed Sano T, Aiko T (2011) New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer 14(2):97–100CrossRefPubMed
26.
go back to reference Zhou J, Shi Y, Tang B, Hao Y, Zeng D, Zhao Y et al (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc 28(6):1779–1787CrossRef Zhou J, Shi Y, Tang B, Hao Y, Zeng D, Zhao Y et al (2014) Robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: comparison of surgical performance and short-term outcomes. Surg Endosc 28(6):1779–1787CrossRef
Metadata
Title
Effect of π-shaped Esophagojejunal Anastomosis in Laparoscopic Total Gastrectomy
Authors
Kai Xu
Jiadi Xing
Maoxing Liu
Ming Cui
Chenghai Zhang
Hong Yang
Zhendan Yao
Nan Zhang
Fei Tan
Pin Gao
Xiangqian Su
Publication date
10-06-2022
Publisher
Springer India
Published in
Indian Journal of Surgery / Issue 2/2023
Print ISSN: 0972-2068
Electronic ISSN: 0973-9793
DOI
https://doi.org/10.1007/s12262-022-03399-z

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