Totally laparoscopic total gastrectomy using the modified overlap method and conventional open total gastrectomy:A comparative study

作     者：Chang Seok Ko Nam Ryong Choi Byung Sik Kim Jeong Hwan Yook Min-Ju Kim Beom Su Kim 

作者机构：Department of SurgeryAsan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea Department of Clinical Epidemiology and BiostatisticsAsan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2021年第27卷第18期

页      面：2193-2204页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：the Institutional Review Board of the Asan Medical Center(approval No.2019-0702) 

主　　题：Laparoscopic surgery Gastrectomy Anastomosis Stomach neoplasms Totally laparoscopic total gastrectomy 

摘      要：BACKGROUND Although several methods of totally laparoscopic total gastrectomy(TLTG)have been *** best anastomosis technique for LTG has not been *** To investigate the effectiveness and surgical outcomes of TLTG using the modified overlap method compared with open total gastrectomy(OTG)using the circular stapled *** We performed 151 and 131 surgeries using TLTG with the modified overlap method and OTG for gastric cancer between March 2012 and December *** and oncological outcomes were compared between groups using propensity score *** addition,we analyzed the risk factors associated with postoperative *** Patients who underwent TLTG were discharged earlier than those who underwent OTG[TLTG(9.62±5.32)vs OTG(13.51±10.67),P0.05].Time to first flatus and soft diet were significantly shorter in TLTG *** pain scores at all postoperative periods and administration of opioids were significantly lower in the TLTG group than in the OTG *** significant difference in early,late and esophagojejunostomy(EJ)-related complications or 5-year recurrence free and overall survival between *** analysis demonstrated that body mass index[odds ratio(OR),1.824;95%confidence interval(CI):1.029-3.234,P=0.040]and American Society of Anaesthesiologists(ASA)score(OR,3.154;95%CI:1.084-9.174,P=0.035)were independent risk factors of early ***,age was associated with≥3 Clavien-Dindo classification and EJrelated *** Although TLTG with the modified overlap method showed similar complication rate and oncological outcome with OTG,it yields lower pain score,earlier bowel recovery,and *** should perform total gastrectomy cautiously and delicately in patients with obesity,high ASA scores,and older ages.