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digestive tract reconstruction in pancreaticoduodenectomy in University Hospitals of China: a national questionnaire survey

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Journal of Pancreatology 2022年第3期5卷 127-152页

作者： Jishu Wei Qiang Xu Yuhua Zhang Jiabin Jin Xiaodong Tian Qiaofei Liu Zipeng Lu Zheng Wang Shanmiao Gou Song Gao Xianlin Han Yefei Rong Niandong Ji Ye Lin Guolin Li Shi Chen Feng Cao Hua Chen Wenming Wu Yupei Zhao the Young Elite Pancreatic Surgery Club of China Pancreas Center The First Affiliated Hospital of Nanjing Medical UniversityNanjing Department of General Surgery State Key Laboratory of Complex and Rare DiseasesPeking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing Department of Hepatobiliary and Pancreatic Surgery The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital)Institute of Basic Medicine and Cancer(IBMC)Chinese Academy of SciencesHangzhou Department of General Surgery Pancreatic Disease CenterRuijin HospitalShanghai Jiao Tong University School of MedicineShanghai Department of General Surgery Peking University First HospitalBeijing Department of Hepatobiliary Surgery the First Affiliated Hospital of Xi’an Jiaotong UniversityPancreas Center of Xi’an Jiaotong University Department of Pancreatic Surgery Union HospitalHuazhong University of Science and TechnologyWuhan Department of Pancreatic Carcinoma Tianjin Medical University Cancer Hospital and InstituteTianjin Department of pancreatic surgery Zhongshan HospitalFudan UniversityShanghai Department of General Surgery Xiangya HospitalCentral South UniversityChangsha Department of Hepatobiliary Surgery Guangdong Provincial People's HospitalGuangdong Academy of Medical SciencesGuangzhou Department of Hepatobiliary Pancreatic and Splenic Surgerythe Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhou Department of Hepato-biliary-pancreatic Surgery Fujian Provincial HospitalFuzhou Department of General Surgery Xuanwu HospitalCapital Medical UniversityBeijing Department of Pancreatic and Biliary Surgery Harbin Medical UniversityHarbin 不详

Background Pancreaticoduodenectomy(PD)has been widely applied in general hospitals in China;however,there is still a lack of unified standards for each surgical technique and procedure.This survey is intended to investigate the current status of digestive tract reconstruction after PD in university hospitals in China.Method A cross-sectional survey was conducted among the members of the Young Elite Pancreatic Surgery Club of China by using the Questionnaire for digestive tract reconstruction after Pancreaticoduodenectomy.The questionnaire was disseminated and collected by point-to-point communication via WeChat public platforms.Results A total of 73 valid questionnaires were returned from 65 university hospitals in 28 provincial divisions of China's Mainland.The respondents who performed PD surgery with an annual volume of over 100 cases accounted for 63%.Generally,laparoscopic PD was performed less often than open PD.Child and Whipple reconstructions accounted for 70%and 26%,respectively.The sequence of pancreatoenteric,biliary-enteric,and gastrointestinal reconstruction accounted for 84%of cases.In pancreatoenteric anastomosis,double-layer anastomosis is the most commonly employed type,accounting for approximately 67%,while single-layer anastomosis accounts for 30%.Of the double-layer anastomoses,duct-to-mucosa/dunking(94%/4%)PJ was performed with duct-mucosa using the Blumgart method(39%)and Cattel-Warren(29%),with continuous/interrupted sutures in the inner layer(69%/31%)and continuous/interrupted sutures in the outer layer(53%/23%).In single-layer anastomosis,continuous/interrupted sutures accounted for 41%/45%.In hepatojejunostomy,single-layer/double-layer suture accounted for 79%/4%,and continuous/interrupted suture accounted for 75%/9%.Forty-six percent of the responding units had not applied double-layer biliary-intestinal anastomosis in the last 3 years,75%of the responding surgeons chose the anastomosis method according to bile duct diameter,with absorbable/non-absorbable suture accounting for 86%/12%.

关键词： Pancreaticoduodenectomy digestive tract reconstruction University hospitals Questionnaire survey

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digestive tract reconstruction options after laparoscopic gastrectomy for gastric cancer

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World Journal of Gastrointestinal Oncology 2020年第1期12卷 21-36页

作者： Jian Shen Xiang Ma Jing Yang Jian-Ping Zhang Department of General Surgery The Second Affiliated Hospital of Nanjing Medical UniversityNanjing 210011Jiangsu ProvinceChina Cardiovascular Center The Second Affiliated Hospital of Nanjing Medical UniversityNanjing 210011Jiangsu ProvinceChina

In addition to the popularity of laparoscopic gastrectomy(LG),many reconstructive procedures after LG have been reported.Surgical resection and lymphatic dissection determine long-term survival;however,the election of a reconstruction procedure determines the postoperative quality of life for patients with gastric cancer(GC).Presently,no consensus exists regarding the optimal reconstructive procedure.In this review,the current state of digestive tract reconstruction after LG is reviewed.According to the determining influence of the tumor site on the procedures of surgical resection and reconstruction,we divide these reconstruction procedures into three categories consistent with the resection procedures.We focus on the technical tips of every reconstruction procedure and examine the surgical outcomes(length of surgery and blood loss)and postoperative complications(anastomotic leakage and stricture)to facilitate gastrointestinal surgeons to understand the merits and demerits of every reconstruction procedure.

关键词： digestive tract reconstruction Laparoscopic gastrectomy Gastric cancer Quality of life

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Effects on the pouch of different digestive tract reconstruction modes assessed by radionuclide scintigraphy

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World Journal of Gastroenterology 2010年第11期16卷 1402-1408页

作者： Li, Dong-Sheng Xu, Hui-Mian Han, Chun-Qi Li, Ya-Ming China Med Univ Affiliated Hosp 1 Dept Oncol Shenyang 110001 Liaoning Prov Peoples R China

AIM: To determine the effect of three digestive tract reconstruction procedures on pouch function, after radical surgery undertaken because of gastric cancer, as assessed by radionuclide dynamic imaging. METHODS: As a measure of the reservoir function, with a designed diet containing technetium-99m (99mTc), the emptying time of the gastric substitute was evaluated using a 99mTc-labeled solid test meal. Immediately after the meal, the patient was placed in front of a γ camera in a supine position and the radioactivity was measured over the whole abdomen every minute. A frame image was obtained. The emptying sequences were recorded by the microprocessor and then stored on a computer disk. According to a computer processing system, the half-emptying actual curve and the fitting curve of food containing isotope in the detected region were depicted, and the half-emptying actual curves of the three reconstruction procedures were directly compared. RESULTS: Of the three reconstruction procedures, the half-emptying time of food containing isotope in the Dual Braun type esophagojejunal anastomosis procedure (51.86±6.43 min) was far closer to normal, signif icantly better than that of the proximal gastrectomy orthotopic reconstruction (30.07±15.77 min, P=0.002) and P type esophagojejunal anastomosis (27.88±6.07 min, P=0.001) methods. The half-emptying actual curve and f itting curves for the Dual Braun type esophagojejunal anastomosis were fairly similar while those of the proximal gastrectomy orthotopic reconstruction and P type esophagojejunal anastomosis were obviously separated, which indicated bad food conservation in the reconstructed pouches. CONCLUSION: Dual Braun type esophagojejunal anastomosis is the most useful of the three procedures for improving food accommodation in patients with a pouch and can retard evacuation of solid food from the reconstructed pouch.

关键词： Isotope γ-scintigraphy T1/2 time digestive tract reconstruction 99mTc-DTPA Emptying time

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Comparison of long-term quality of life between Billroth-I and Roux-en-Y anastomosis after distal gastrectomy for gastric cancer: a randomized controlled trial

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Chinese Medical Journal 2023年第9期136卷 1074-1081页

作者： Kun Yang Weihan Zhang Zehua Chen Xiaolong Chen Kai Liu Linyong Zhao Jiankun Hu Department of General Surgery&Laboratory of Gastric Cancer State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer CenterWest China HospitalSichuan UniversityChengduSichuan 610041China Gastric Cancer Center West China HospitalSichuan UniversityChengduSichuan 610041China

Background:The results of studies comparing Billroth-I(B-I)with Roux-en-Y(R-Y)reconstruction on the quality of life(QoL)are still inconsistent.The aim of this trial was to compare the long-term QoL of B-I with R-Y anastomosis after curative distal gastrectomy for gastric cancer.Methods:A total of 140 patients undergoing curative distal gastrectomy with D2 lymphadenectomy in West China Hospital,Sichuan University from May 2011 to May 2014 were randomly assigned to the B-I group(N=70)and R-Y group(N=70).The follow-up time points were 1,3,6,9,12,24,36,48,and 60 months after the operation.The final follow-up time was May 2019.The clinicopathological features,operative safety,postoperative recovery,long-term survival as well as QoL were compared,among which QoL score was the primary outcome.An intention-to-treat analysis was applied.Results:The baseline characteristics were comparable between the two groups.There were no statistically significant differences in terms of postoperative morbidity and mortality rates,and postoperative recovery between the two groups.Less estimated blood loss and shorter surgical duration were found in the B-I group.There were no statistically significant differences in 5-year overall survival(79%[55/70]of the B-I group vs.80%[56/70]of the R-Y group,P=0.966)and recurrence-free survival rates(79%[55/70]of the B-I group vs.78%[55/70]of the R-Y group,P=0.979)between the two groups.The scores of the global health status of the R-Y group were higher than those of the B-I group with statistically significant differences(postoperative 1 year:85.4±13.1 vs.88.8±16.1,P=0.033;postoperative 3 year:87.3±15.2 vs.92.8±11.3,P=0.028;postoperative 5 year:90.9±13.7 vs.96.4±5.6,P=0.010),and the reflux(postoperative 3 year:8.8±12.9 vs.2.8±5.3,P=0.001;postoperative 5 year:5.1±9.8 vs.1.8±4.7,P=0.033)and epigastric pain(postoperative 1 year:11.8±12.7 vs.6.1±8.8,P=0.008;postoperative 3 year:9.4±10.6 vs.4.6±7.9,P=0.006;postoperative 5 year:6.0±8.9 vs.2.7±4.6,P=0.022)were milder in the R-Y group than those of the B-

关键词： Gastric cancer Distal gastrectomy digestive tract reconstruction Billroth-I anastomosis Roux-en-Y anastomosis Quality of life

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Anti-reflux effects of a novel esophagogastric asymmetric anastomosis technique after laparoscopic proximal gastrectomy

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1761-1773页

作者： Li-Qun Pang Jie Zhang Fang Shi Cong Pang Cheng-Wan Zhang Ye-Liu Liu Yao Zhao Yan Qian Xiang-Wei Li Dan Kong Shang-Nong Wu Jing-Fang Zhou Cong-Xue Xie Song Chen Department of General Surgery The Affiliated Huaian No.1 People's Hospital of Nanjing Medical UniversityHuaian 223300Jiangsu ProvinceChina Jiangsu Key Laboratory of Advanced Manufacturing Technology Huaiyin Institute of TechnologyHuaian 223300Jiangsu ProvinceChina Department of Neurosurgery The Affiliated Huaian No.1 People's Hospital of Nanjing Medical UniversityHuaian 223300Jiangsu ProvinceChina Department of Central Laboratory The Affiliated Huaian No.1 People's Hospital of Nanjing Medical UniversityHuaian 223300Jiangsu ProvinceChina Department of Imaging The Affiliated Huaian No.1 People's Hospital of Nanjing Medical UniversityHuaian 223300Jiangsu ProvinceChina Department of Gastroenterology The Affiliated Huaian No.1 People's Hospital of Nanjing Medical UniversityHuaian 223300Jiangsu ProvinceChina Institute of Medicinal Biotechnology Jiangsu College of NursingHuaian 223300Jiangsu ProvinceChina

BACKGROUND Reflux esophagitis is a common postoperative complication of proximal gastrectomy.There is an urgent need for a safer method of performing esophageal-gastric anastomosis that reduces the risk of reflux after proximal gastrectomy.We hypothesize that a novel technique termed esophagogastric asymmetric anastomosis(EGAA)can prevent postoperative reflux in a safe and feasible manner.To observe a novel method of EGAA to prevent postoperative reflux.METHODS Initially,we employed a thermal stress computer to simulate and analyze gastric peristalsis at the site of an esophagogastric asymmetric anastomosis.This was done in order to better understand the anti-reflux function and mechanism.Next,we performed digestive tract reconstruction using the EGAA technique in 13 patients who had undergone laparoscopic proximal gastrectomy.Post-surgery,we monitored the structure and function of the reconstruction through imaging exams and gastroscopy.Finally,the patients were followed up to assess the efficacy of the anti-reflux effects.RESULTS Our simulation experiments have demonstrated that the clockwise contraction caused by gastric peristalsis and the expansion of the gastric fundus caused by the increase of intragastric pressure could significantly tighten the anastomotic stoma,providing a means to prevent the reverse flow of gastric fluids.Thirteen patients with esophagogastric junction tumors underwent laparoscopic proximal gastrectomy,with a mean operation time of 304.2±44.3 min.After the operation,the upper gastroenterography in supine/low head positions showed that eight patients exhibited no gastroesophageal reflux,three had mild reflux,and two had obvious reflux.The abdominal computed tomography examination showed a valve-like structure at the anastomosis.During followup,gastroscopy revealed a closed valve-like form at the anastomosis site without stenosis or signs of reflux esophagitis in 11 patients.Only two patients showed gastroesophageal reflux symptoms and mild reflux esophagitis and were treated with proto

关键词： Esophagogastric junction tumor Proximal gastrectomy digestive tract reconstruction Esophagogastric asymmetric anastomosis Reflux esophagitis Gastroenterography

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