The advantages of circular stapling instrument compared with Albert-Lembert suture for anastomosis of Billroth I gastrectomy for gastric cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14104-14104
Author(s):  
H. Imamura ◽  
H. Furukawa ◽  
M. Tatsuta ◽  
T. Kishimoto ◽  
K. Yamamoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Distal Gastrectomy ◽  
Circular Stapler ◽  
Purse String ◽  
Billroth I ◽  
Anastomotic Bleeding ◽  
Group A ◽  
Group B ◽  
Linear Cutter

14104 Background: In Japan, reconstruction with Billroth I using Albert-Lembert suture had been usually performed in distal gastrectomy for gastric cancer. However stapling instruments have within recent years gained wide acceptance not only in total gastrectomy but also in distal gastrectomy. We have introduced circular stapling instrument for anastomosis reconstructed with Billroth I since June 2001. Methods: 111 and 222 patients with gastric cancer underwent distal gastrectomy reconstructed with Billroth I using Albert-Lembert suture from June 1999 to May 2001 (Group A) and using circular stapling instrument from June 2001 to December 2003 (Group B) for anastmosis in our institute, respectively. Albert-Lembert suture was performed as end-to-end gastroduodenostomy followed by resection of proximal line stapled across with liner cutter instrument. The procedure of anastomosis using circular stapling instrument was as followed; the distal duodenum was clamped with the purse-string instrument, divided proximally, the anvil was attached, the purse-string was tied down, the circular stapler without anvil was inserted through a gastrotomy, brought out through a stab wound at the anastomosis site, the instrument was closed and fired, and gastrectomy involving the site of gastrotomy was closed with linear cutter instrument. The followed-up periods of all patients from surgery were more than 2 years. We retrospectively compared the incidence of anastomosis-related complications within 2 years from surgery consisting of anastomotic bleeding, leakage, and stenosis. P-values were calculated statistically using χ2-test. Results: Anastomotic bleeding occurred in 1 (0.45%) patient of Group B, but in none of Group A (P=0.48). Anastomotic leakage occurred in 2 patients (1.80%) of Group A, but in none of Group B (P=0.045). Anastomotic stenosis occurred in 2 patients (0.90%) of Group B, but in none of Group A (P=0.32). All complications were recovered and all patients left hospital in the safety. Conclusions: Our data indicated that circular stapling instrument for anastomosis of Billroth I gastrectomy for gastric cancer significantly reduced the incidence of anastomotic leakage compared with Albert-Lembert suture. No significant financial relationships to disclose.

scholarly journals Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Junfeng Zhou ◽  
Sheng Lin ◽  
Sida Sun ◽  
Chengying Zheng ◽  
Jiaxing Wang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Immune Function ◽  
Cancer Patients ◽  
Distal Gastrectomy ◽  
Single Incision ◽  
Laparoscopic Distal Gastrectomy ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Gastric Cancer Patients

Abstract Background To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS). Methods A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery. Results The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P < 0.05). There were no significant differences in preoperative CD3+, CD4+, CD8+, natural killer (NK) cells, CD4+/CD8+, IgA, IgM and IgG levels between two groups (P < 0.05). Three days after surgery, the immune function indices were decreased in both groups, but with no significant difference between two groups (P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P < 0.05). The 3-year survival rate were 96.7% in group A and 91.7% in group B, respectively, with no statistically significant difference. Conclusion Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.

scholarly journals Amniotic Membrane Transplantation in the Treatment of Primary Pterygium: A Comparative Study of Two Techniques

2014 ◽  
Vol 48 (1) ◽  
pp. 1-7
Author(s):  
Reema Bansal ◽  
R Sehgal
Keyword(s):  
Comparative Study ◽  
Amniotic Membrane ◽  
Free Edge ◽  
Amniotic Membrane Transplantation ◽  
Human Amniotic Membrane ◽  
Purse String ◽  
Group A ◽  
End To End ◽  
Group B ◽  
Primary Pterygium

ABSTRACT Purpose To compare two techniques of human amniotic membrane transplantation (AMT) following pterygium excision: (1) end to end suturing of the amniotic membrane graft (AMG) with the conjunctiva versus (2) a new technique of purse-string suturing of the AMG and tucking of AMG under the free edge of conjunctiva. Materials and methods Pterygium surgery with human AMT was done in 42 eyes with primary pterygium. Twenty four eyes (group A) underwent end-to-end suturing of AMG with conjunctiva. Eighteen eyes (group B) underwent purse-string suturing of AMG with underlying sclera with free edge of AMG tucked under conjunctiva on three sides. The two groups were compared in terms of the outcome measures, i.e. complete epithelialization time of AMG and recurrence of pterygium within 1 year. Results The complete epithelialization of AMG occurred in 21 days (range 14 to 28 days) and 14 days (range 7 to 21 days) in groups A and B respectively. In group A, 7 eyes (29.17%) developed recurrence. In group B, 2 eyes (11.11%) developed recurrence. Conclusion Purse string suturing and tucking of AMG resulted in faster epithelization of AMG and lower recurrences in comparison with end to end suturing of AMG in the management of primary pterygium. How to cite this article Bansal R, Jain AK, Sehgal R. Amniotic Membrane Transplantation in the Treatment of Primary Pterygium: A Comparative Study of Two Techniques. J Postgrad Med Edu Res 2014;48(1):1-7.

scholarly journals Adjuvant chemotherapy is an additional option for locally advanced gastric cancer after radical gastrectomy with D2 lymphadenectomy: a retrospective control study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lei Chen ◽  
Chenghai Zhang ◽  
Zhendan Yao ◽  
Ming Cui ◽  
Jiadi Xing ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Stage Ii ◽  
Radical Gastrectomy ◽  
D2 Lymphadenectomy ◽  
D2 Gastrectomy ◽  
Group A ◽  
Group B

Abstract Background This study compared the long-term efficacy of different durations of adjuvant chemotherapy for patients with gastric cancer after radical gastrectomy with D2 lymphadenectomy. Methods We retrospectively identified 428 patients with stage II–III gastric cancer who underwent D2 gastrectomy between 2009 and 2016. Patients were divided into four groups according to the duration of adjuvant chemotherapy, including 0 week (no adjuvant, group A), 20 to 24 weeks (completed 7–8 cycles every 3 weeks or 10–12 cycles every 2 weeks, group B), and 12 to18 weeks (completed 4–6 cycles every 3 weeks or 6–9 cycles every 2 weeks, group C), and less than 12 weeks (received up to 3 cycles every 3 weeks or 5 cycles every 2 weeks, group D). The chemotherapy regimens included XELOX, SOX, and FOLFOX. 5-year overall survival (OS) and disease-free survival (DFS) were analyzed. Results The 5-year OS rates for groups A, B, C, and D were 52.3, 73.7, 72.0, and 53.3%, respectively, and the 5-year DFS rates were 50.0, 68.0, 65.4, and 50.0%, respectively. OS and DFS were higher in group B than in groups A and D. Similarly, patients in group C were more likely to have higher OS and DFS than those in groups A and D. Meanwhile, there were no significant differences in OS and DFS between groups B and C. The multivariate analysis confirmed with high statistical significance the efficacy of complete courses of adjuvant chemotherapy, and, among them, the similar impact of 4–6/6–9 and 7–8/10–12 cycles, resulting in similar HRs vs Group A (0.52 and 0.42, respectively). Conclusions To reduce toxicity and maintain efficacy, XELOX or SOX chemotherapy regimens administered for 4–6 cycles every 3 weeks or FOLFOX regimen for 6–9 cycles every 2 weeks might be a favorable option for patients with stage II–III gastric cancer after D2 gastrectomy. Prospective multicenter clinical trials with adequate sample sizes are necessary to verify these findings.

A prospective, randomized, controlled, multicenter study of apatinib combined with S-1 plus docetaxel as adjuvant therapy for locally advanced gastric cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16019-e16019
Author(s):  
Zhili Shan ◽  
Feng Guo ◽  
Hong Chen ◽  
Dapeng Li ◽  
Zhongqi Mao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Randomized Controlled ◽  
Locally Advanced Gastric Cancer ◽  
Group A ◽  
Group B ◽  
Disease Free

e16019 Background: Postoperative adjuvant chemotherapy is commonly given after the curative resection of gastric cancer (GC) in both Eastern and Western countries. Several studies have investigated the feasibility and safety of S-1 plus docetaxel or S-1 plus cisplatin. However, the best choice of adjuvant treatment for patients with gastric cancer is still debated. Apatinib, an oral small molecular of VEGFR-2 TKI, has been confirmed to improve OS and PFS with acceptable safety profile in patients with advanced gastric cancer refractory to two or more lines of prior chemotherapy. In this study, we aimed to evaluate the efficacy and safety of apatinib combined with S-1/docetaxel for locally advanced gastric cancer (T3-4aN+M0). Methods: This is a prospective, randomized, controlled, multicenter clinical study. Patients with locally advanced gastric cancer, pathological stage T3-4aN+M0 who underwent D2 lymphadenectomy without prior anti-cancer therapy were included. All these patients were assigned to group A or B. Patients in group A received 6 cycles (21 days a cycle) of adjuvant therapy using S-1 (80-120mg/d, d1-14), and docetaxel (40mg/m2, d1). Group B received the same regimen with the addition of apatinib (250mg, qd.). The primary endpoint was disease-free survival (DFS). The final analysis cutoff date was 30 November, 2020. Results: A total of 45 patients were enrolled from January 2019 to November, 2010 and assigned to group A (21) or group B (24). The DFS was not reached in both of the groups. The 1-year disease-free survival rate was 60% in group A and 90% in the group B, while the difference was not significant. The main AEs in group A were anemia (55%), nausea (50%) and neutropenia (40%); The most common AEs in group B were anemia (45%) neutropenia (40%) and diarrhea (25%). There were no treatment-related deaths. The longest administered time of apatinib with no progression was 457 days. And the median time to receive apatinib was 329 days. Conclusions: Combination of apatinib with S-1/docexal chemotherapy shows clinical benefits in locally advanced gastric cancer (T3-4aN+M0), with tolerable toxicity. The study is still ongoing to reach our final endpoint, DFS. Clinical trial information: ChiCTR2000038900.

RA05.08: OPTIMAL RADIATION DOSE IN THE NEOADJUVANT TREATMENT OF ESOPHAGEAL CANCER: A COMPARATIVE EUROPEAN STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 29-29
Author(s):  
Styliani Mantziari ◽  
Pierre Allemann ◽  
Michael Winiker ◽  
Marguerite Messier ◽  
Nicolas Demartines ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Esophageal Cancer ◽  
Radiation Dose ◽  
Anastomotic Leakage ◽  
Disease Free Survival ◽  
Free Survival ◽  
Group A ◽  
Group B ◽  
Disease Free

Abstract Background Current guidelines recommend the use of neoadjuvant chemo-radiation (NCR) for the treatment of locally advanced esophageal cancer, both types, adenocarcinoma (AC) and squamous cell carcinoma (SCC). So far, the optimal dose of radiotherapy to achieve a maximal tumor response within an acceptable toxicity is not yet determined. The aim of this study was to assess the impact of preoperative radiation dose on postoperative outcomes and long-term survival. Methods Consecutive patients operated in two European tertiary centers for AC or SCC, treated with NCR and surgery from 2000–2016 were assessed. Specific postoperative complications (i.e. anastomotic leakage, atrial fibrillation), histological tumor regression grade (TRG, Mandard score), overall and disease-free survival were compared among three patients groups: group A (41.4Gy), group B (45Gy), and group C (50.4Gy). The x2 or Fisher test were used for categorical variables and ANOVA for continuous variables. Survival analysis was done with the Kaplan-Meier method and log-rank test. Results There were 294 patients included; 41.5% (n = 122) had AC and 58.5% (n = 172) SCC. Overall, 9.2%/27 patients received 41Gy, 57.8%/170 patients 45Gy and 33%/97 patients received 50.4Gy. Carboplatin-Paclitaxel was the most frequently used chemotherapy for group A (62.9%), and 5FU-Cisplatin for groups B (69.4%) and C (51.5%). Postoperative anastomotic leakage was lower for group B (7.1%) compared to group A (22.2%) and C (13.4%) (P = 0.036), as was the occurrence of atrial fibrillation (11.8% group B, 33.3% group A and 19.6% group C, P = 0.013). Complete or excellent response (TRG 1–2) was significantly better for group B (58.2%), followed by group C (49.5%) and A (25.9%) patients (P = 0.012). Median overall survival was 48, 27 and 29 months for group A, B and C (P = 0.498), and median disease-free survival was 13, 27 and 18 months (P = 0.411), respectively. Conclusion Preoperative radiotherapy dose of 45Gy with 5FU-Cisplatin was associated with a better histological response and less postoperative adverse outcomes compared to 41Gy and 50.4Gy, with no significant differences in long-term recurrence and survival. The role of the type of chemotherapy and histological tumor type are important co-factors affecting outcome and must be further assessed. Disclosure All authors have declared no conflicts of interest.

Laparoscopy-assisted distal gastrectomy with intracorporeal Billroth I stapled anastomosis using a hand access device for patients with gastric cancer

2007 ◽  
Vol 21 (6) ◽  
pp. 859-862 ◽  
Author(s):  
Y. -T. Joo ◽  
H. -G. Moon ◽  
S. H. Lee ◽  
C. -Y. Jeong ◽  
E. -J. Jung ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Distal Gastrectomy ◽  
Stapled Anastomosis ◽  
Access Device ◽  
Billroth I

scholarly journals Laparoscopy-Assisted Distal Gastrectomy for an Early Gastric Cancer Patient With Situs Inversus Totalis

2013 ◽  
Vol 98 (3) ◽  
pp. 266-270 ◽  
Author(s):  
Hirohito Fujikawa ◽  
Takaki Yoshikawa ◽  
Toru Aoyama ◽  
Tsutomu Hayashi ◽  
Haruhiko Cho ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Cancer Patient ◽  
Gastric Cancer Patient ◽  
Situs Inversus ◽  
Distal Gastrectomy ◽  
Operating Time ◽  
Situs Inversus Totalis ◽  
Billroth I ◽  
Billroth I Reconstruction

Abstract Situs inversus totalis (SIT) is a congenital condition in which there is complete right to left reversal of the thoracic and abdominal organs. This report describes laparoscopy-assisted distal gastrectomy (LADG) for an early gastric cancer patient with SIT. The preoperative diagnosis was c-stage IA (cT1a cN0 cH0 cP0 cM0). LADG with D1+ dissection and Billroth-I reconstruction was successfully performed by standing at the opposite position. The operating time was 234 minutes and blood loss was 5 mL. Although a mechanical obstruction occurred after surgery, the patient recovered after re-operation with Roux-en-Y bypass.

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