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esophagojejunostomy after laparoscopic total gastrectomy by Or VilTM or hemi-double stapling technique

World Journal of Gastroenterology 2015年第29期21卷 8943-8951页

作者： Hao Wang Qun Hao Meng Wang Min Feng Feng Wang Xin Kang Wen-Xian Guan Department of General Surgery Drum Tower Hospital Medical School of Nanjing University Department of Obstetrics and Gynecology Jinling Hospital Medical School of Nanjing University

AIM: To investigate the feasibility, advantages and disadvantages of two types of anvil insertion techniques for esophagojejunostomy after laparoscopic total ***: This was an open-label prospective cohort study. Laparoscopy-assisted radical total gastrectomy with D2 lymph node dissection was performed in 84 patients with primary non-metastatic gastric cancer confirmed by pre-operative histological examination. Overweight patients were excluded, as well as patients with peritoneal dissemination and invasion of adjacent organs. After total gastrectomy, all patients were randomized into two groups. Patients in Group Ⅰ underwent esophagojejunostomy using a transorally-inserted anvil(Or VilTM), while patients in Group Ⅱ underwent esophagojejunostomy using the hemi-double stapling technique(HDST). Both types of esophagojejunostomy were performed under laparoscopy. Patients' baseline characteristics, preoperative characteristics, perioperative characteristics, short-term postoperative outcomes and operation cost were comparedbetween the two groups. The primary endpoint was evaluation of the surgical outcome(operating time, time of digestive tract reconstruction and time of anvil insertion) and the medical cost of each operation(operation cost and total cost of hospitalization). The secondary endpoints were time to solid diet, post-surgical hospitalization time, time to defecation, time to ambulation and intra-operative blood loss. In addition, complications were assessed and compared. RESULTS: Laparoscopic total gastrectomy and esophagojejunostomy were successfully performed in all 84 patients, without conversion to laparotomy. There were no significant differences in the operative time and time for total gastrectomy between the two groups(287.8 ± 38.4 min vs 271.8 ± 46.1 min, P = 0.09, and 147.7 ± 31.6 min vs 159.8 ± 33.8 min, P = 0.09, respectively). The time for digestive tract reconstruction and for anvil insertion were significantly decreased in Group

关键词： Laparoscopy Gastrectomy Gastric cancer esophagojejunostomy Cohort analysis

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Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience

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World Journal of Gastroenterology 2016年第12期22卷 3432-3440页

作者： Ke Chen Yu Pan Jia-Qin Cai Xiao-Wu Xu Di Wu Jia-Fei Yan Rong-Gao Chen Yang He Yi-Ping Mou Department of General Surgery Sir Run Run Shaw Hospital School of Medicine Institute of Micro-Invasive Surgery Zhejiang University

AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric ***: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical ***: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 m L. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%.However, there were no cases of postoperative ***: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

关键词： Gastric cancer Total gastrectomy esophagojejunostomy Laparoscopy Hand-sewn

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对比经口置入砥钉座方法进行食管空肠吻合与使用圆形吻合器进行腔外吻合应用于Siewert 2型食管胃结合部腺癌全胃切除后消化道重建的安全性

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Gastroenterology Report 2020年第3期8卷 242-251,I0002页

作者： Xin-Hua Chen Yan-Feng Hu Jun Luo Yue-Hong Chen Hao Liu Tian Lin Hao Chen Guo-Xin Li Jiang Yu Department of General Surgery Nanfang HospitalSouthern Medical UniversityGuangzhouGuangdongP.R.China

背景:对于近端胃癌全胃切除后消化道重建,采用经口置入砥钉座方法进行腔内食管空肠吻合已被证明是安全可行的。但尚未见到该方法用于Siewert 2型食管胃结合部腺癌(AEG)的评估报道。方法:2008年1月至2016年12月间,428例连续胃癌患者在广... 详细信息

背景:对于近端胃癌全胃切除后消化道重建,采用经口置入砥钉座方法进行腔内食管空肠吻合已被证明是安全可行的。但尚未见到该方法用于Siewert 2型食管胃结合部腺癌(AEG)的评估报道。方法:2008年1月至2016年12月间,428例连续胃癌患者在广州南方医院接受腹腔镜全胃切除术,其中98例被归为Siewert 2型AEG。在98例AEG患者中,27例采用经口置入砥钉座方法进行腔内食管空肠吻合(经口组),71例采用圆形吻合器进行腔外食管空肠吻合(腔外组)。在基于吻合口漏危险因素进行1:1的倾向评分匹配后,26对匹配患者纳入分析。比较两组患者术后30天的安全性。结果:两组患者基线资料均衡。手术时间、消化道重建耗时、淋巴结清扫数量、近切缘长度、术中失血量、术中并发症发生率和术后恢复时间两组差异均无统计学意义。经口组相较腔外组,砥钉座置入时间更短(平均数:9.7 vs 13.4 min,P<0.001),手术切口更短(中位数:5.5 vs 7.0 cm,P<0.001)。术后并发症发生率两组差异无统计学意义(26.9%vs 23.1%,P¼0.749),并发症严重程度亦无显著差异(P¼0.939)。结论:采用经口置入砥钉座方法进行腔内食管空肠吻合,用以简化并优化Siewert 2型AEG患者全胃切除术后的消化道重建,是潜在安全的。

关键词： adenocarcinoma of the esophagogastric junction laparoscopic total gastrectomy esophagojejunostomy anastomotic leakage

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High yield reproducible rat model recapitulating human Barrett's carcinogenesis

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World Journal of Gastroenterology 2017年第33期23卷 6077-6087页

作者： Daisuke Matsui Ashten N Omstead Juliann E Kosovec Yoshihiro Komatsu Emily J Lloyd Hailey Raphael Ronan J Kelly Ali H Zaidi Blair A Jobe Esophageal and Lung Institute Allegheny Health Network Department of Gastroenterological Surgery Kanazawa University Hospital Department of Oncology Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins Hospital

AIM To efficiently replicate the biology and pathogenesis of human esophageal adenocarcinoma(EAC) using the modified Levrat model of end-to-side esophagojejunostomy. METHODS End-to-side esophagojejunostomy was performed on rats to induce gastroduodenoesophageal reflux to develop EAC. Animals were randomly selected and serially euthanized at 10(n = 6),17(n = 8),24(n = 9),31(n = 6),38(n = 6),and 40(n = 6) wk postoperatively. The esophagi were harvested for downstream histopathology and gene expression. Histological evaluation wascompleted to determine respective rates of carcinogenic development. Quantitative reverse transcriptionpolymerase chain reaction was performed to determine gene expression levels of MUC2,CK19,and CK20,and results were compared to determine significant differences throughout disease progression *** The overall study mortality was 15%. Causes of mortality included anastomotic leak,gastrointestinal hemorrhage,stomach ulcer perforation,respiratory infection secondary to aspiration,and obstruction due to tumor or late anastomotic stricture. 10 wk following surgery,100% of animals presented with esophagitis. Barrett's esophagus(BE) was first observed at 10 wk,and was present in 100% of animals by 17 wk. Dysplasia was confirmed in 87.5% of animals at 17 wk,and increased to 100% by 31 wk. EAC was first observed in 44.4% of animals at 24 wk and increased to 100% by 40 wk. In addition,two animals at 38-40 wk post-surgery had confirmed macro-metastases in the lung/liver and small intestine,respectively. MUC2 gene expression was progressively down-regulated from BE to dysplasia to EAC. Both CK19 and CK20 gene expression significantly increased in a stepwise manner from esophagitis to EAC. CONCLUSION esophagojejunostomy was successfully replicated in rats with low mortality and a high tumor burden,which may facilitate broader adoption to study EAC development,progression,and therapeutics.

关键词： Esophageal adenocarcinoma gastroeso phageal reflux disease Levrat esophagojejunostomy Experimental rat model Mucin genes Cytokeratins

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Digestive tract reconstruction using isoperistaltic jejunumlater-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

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World Journal of Gastroenterology 2017年第39期23卷 7129-7138页

作者： Ze-Ning Huang Chang-Ming Huang Chao-Hui Zheng Ping Li Jian-Wei Xie Jia-Bin Wang Jian-Xian Lin Jun Lu Qi-Yue Chen Long-Long Cao Mi Lin Ru-Hong Tu Ju-Li Lin Department of Gastric Surgery Fujian Medical University Union Hospital

AIM To evaluate the short-term outcomes and quality of life(Qo L) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-latercut overlap method(IJOM) after totally laparoscopic total gastrectomy(TLTG).METHODS A total of 507 patients who underwent laparoscopic gastrectomy(D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG(group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy(LATG)(group A, n = 456). The short-term outcomes and Qo L were compared between the two groups after 1:2 propensity-score matching(PSM). We used a questionnaire to assess Qo *** Before matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups(P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A(P < 0.05). After matching, group T reported better Qo L in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better Qo L("Have you felt pain" and "Have you had difficulty eating solid food")(P < 0.05).CONCLUSION The IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving Qo L after laparoscopic gastrectomy.

关键词： esophagojejunostomy 重叠以后切割完全 laparoscopic 总数 gastrectomy 生活的质量

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Efficacy of totally laparoscopic compared with laparoscopic-assisted total gastrectomy for gastric cancer: A meta-analysis

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World Journal of Clinical Cases 2020年第5期8卷 900-911页

作者： Song Wang Mei-Lan Su Yang Liu Zhi-Ping Huang Ning Guo Tian-Jin Chen Zhong-Hui Zou Department of Stomach/Thyroid/Vascular Surgery Chongqing Three Gorges Central HospitalChongqing 404000China Department of Psychosomatic Medicine Chongqing Three Gorges Central HospitalChongqing 404000China

BACKGROUND Laparoscopic radical gastrectomy is currently the most common surgical approach for gastric *** main difference between totally laparoscopic total gastrectomy(TLTG)and laparoscopic-assisted total gastrectomy(LATG)is the route of digestive tract ***,TLTG is currently not widespread as the safety and feasibility of intracorporeal esophagojejunostomy is *** To compare the short-term efficacy of TLTG and LATG for radical gastrectomy of gastric cancer,and to determine the safety and feasibility of intracorporeal *** PubMed,EMBASE,and Web of Science databases were searched for all relevant articles regarding TLTG vs LATG for gastric cancer published up to October 1,*** and exclusion criteria were *** the basic conditions of patients and important clinical data related to surgery were extracted,and a meta-analysis was performed with RevMan 5.3 *** Eight studies involving a total of 1883 cases(869 cases in the TLTG group and 1014 cases in the LATG group)were *** with the LATG group,reduced intraoperative blood loss(weighted mean difference=-35.37,95%CI:-61.69--9.06,P=0.008)and a larger number of retrieved lymph nodes(weighted mean difference=3.11,95%CI:-2.60-12.00,P=0.01)were found in the TLTG *** were no significant differences in operating time,anastomotic time,tumor size,proximal resection margin length,postoperative pain score,time to first flatus,time to first oral intake,postoperative hospital stay,postoperative anastomosis-related complication rate and overall complication rate between the two groups(P>0.05).CONCLUSION Intracorporeal esophagojejunostomy is safe and *** has the advantages of being minimally invasive,reduced intraoperative blood loss and easier access to lymph nodes compared with *** laparoscopic gastrectomy is likely to be the surgical trend for gastric cancer in the future.

关键词： Gastric cancer Total gastrectomy esophagojejunostomy Totally laparoscopic Laparoscopic-assisted Meta-analysis

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Laparoscopy-assisted total gastrectomy with trans-orally inserted anvil(OrVil^(TM)):A single institution experience

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World Journal of Gastroenterology 2013年第5期19卷 755-760页

作者： Guan-Qun Liao Xiao-Wei Ou Shi-Qiang Liu Shao-Rui Zhang Wen Huang Department of General Surgery Foshan Affiliated Hospital of South Medical University

AIM:To investigate the feasibility of laparoscopyassisted total gastrectomy(LATG)using trans-orally inserted anvil(OrVilTM)in terms of operative characteristics and short term outcomes. RESULTS:Characteristics of 27 patients with gastric cancer who underwent LATG from October 2009 to October 2012 in the Foshan Affiliated Hospital of South Medical University were retrospectively reviewed. Among these patients,six were reconstructed by minilaparotomy and 21 by *** clinicopathological characteristics,total operation time,total blood loss, abdominal incision and complications of anastomosis including stenosis and leakage,were compared between the groups undergoing LATG with OrVilTM and the group undergoing minilaparotomy. RESULTS:The operations were successfully performed on all the patients without intraoperative complications or conversion to open ***(10%)patients received palliative procedure under laparoscope who were prepared for LATG *** case had hepatic metastatic carcinoma and 1 case had tumor recurrence near the anastomosis 8 mo after *** mean follow-up duration was 10 mo(range,2-24 mo). Operation time was significantly reduced by the use of OrVilTM(198.42±30.28 min vs 240.83±8.23 min). The postoperative course with regard to occurrence of stenosis and leakage was not different between the two *** were no significant differences in estimated blood *** upper abdominal incision was smaller in OrVilTM group than in minilaparotomy group (4.31±0.45 cm vs 6.43±0.38 cm). CONCLUSION:LATG using OrVil TM is a technically feasible surgical procedure with sufficient lymph node dissection,less operation time and acceptable morbidity.

关键词： Total gastrectomy esophagojejunostomy Laparoscopy-assisted total gastrectomy Reconstruction OrVilTM

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