scholarly journals Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

2021 ◽  
Vol 10 ◽  
Author(s):  
Peirong Tian ◽  
Yang Liu ◽  
Shibo Bian ◽  
Mengyi Li ◽  
Meng Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
Anastomotic Stenosis ◽  
Proximal Gastric Cancer ◽  
Laparoscopic Proximal Gastrectomy

BackgroundTo compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer.MethodsOriginal English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer).ResultsFourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = −13.33, 95% CI: −15.66 to −11.00, P < 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = −42.51, 95% CI: −58.99 to −26.03, P < 0.00001), less intraoperative blood loss (WMD = −79.52, 95% CI: −116.63 to −42.41, P < 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG.ConclusionLPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.

scholarly journals Comparative analysis of laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis with laparoscopic total gastrectomy for adenocarcinoma of the esophagogastric junction: a single-center retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yupeng Wu ◽  
Shihao Zhang ◽  
Liting Wang ◽  
Xuya Hu ◽  
Zhanxue Zhang
Keyword(s):  
Weight Loss ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
Reconstruction Method ◽  
Postoperative Reflux ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy

Abstract Background We invented a new antireflux anastomosis method for use in proximal gastrectomy for adenocarcinoma of the esophagogastric junction (AEG) and named it semi-embedded valve anastomosis (SEV). This study was conducted to compare and analyze the short-term efficacy and long-term prognosis of this anastomosis reconstruction method versus laparoscopic total gastrectomy (LTG). Methods We retrospectively analyzed the general data and surgical outcomes of patients with AEG who underwent three united laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis (TULPG-SEV, N = 20) and LTG (N = 20) at our hospital from January 2015 to September 2017 and investigated the incidence of postoperative reflux esophagitis and postoperative nutritional status between the two groups. Survival analysis was also performed. Results The operative time (178.25 ± 15.41 vs 196.5 ± 21.16 min) and the gastrointestinal reconstruction time (19.3 ± 2.53 vs 34.65 ± 4.88 min) of the TULPG-SEV group were significantly less than that of the LTG group. There was no difference in intraoperative blood loss, length of hospital stay, and postoperative complications. There was no difference in the scores on the postoperative reflux disease questionnaires (RDQs) conducted 1 month (P = 0.501), 3 months (P = 0.238), and 6 months (P = 0.655) after surgery between the TULPG-SEV group and LTG group. Gastroscopy revealed 2 cases of reflux esophagitis (grade B or higher) in each group. The postoperative hemoglobin level was better in the TULPG-SEV group than in the LTG group, and the difference was most noticeable at 1 month after surgery (P = 0.024) and 3 months after surgery (P = 0.029). The levels of albumin and total protein were not significantly different between the groups. There were more patients with weight loss over 5 kg after surgery in the LTG group than in the TULPG-SEV group (P = 0.043). There was no significant difference in the 3-year overall survival rate between the two groups (P = 0.356). Conclusion SEV has a certain antireflux effect and can reduce the anastomosis time. Proximal gastrectomy may be better than total gastrectomy for maintaining postoperative hemoglobin levels and reducing weight loss.

scholarly journals Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuo-meng Xiao ◽  
Ping Zhao ◽  
Zhi Ding ◽  
Rui Xu ◽  
Chao Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Operation Time ◽  
Nutrition Status ◽  
Proximal Gastric Cancer ◽  
Double Tract Reconstruction ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy ◽  
Gastric Cancer Patients ◽  
Upper Third

Abstract Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

Kinh nghiệm qua 126 bệnh nhân phẫu thuật nội soi cắt toàn bộ dạ dày điều trị ung thư dạ dày

2021 ◽  
Author(s):  
Van Huong Nguyen
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Total Gastrectomy ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Linear Stapler ◽  
The Mean ◽  
End To End ◽  
Mean Time

TÓM TẮT Đặt vấn đề: Báo cáo kinh nghiệm về kỹ thuật phẫu thuật nội soi cắt toàn bộ dạ dày qua 126 bệnh nhân điều trị ung thư dạ dày tại Bệnh viện Hữu nghị Đa khoa Nghệ An. Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả hồi cứu, các bệnh nhân được phẫu thuật nội soi cắt toàn bộ dạ từ 2014 đến 05/2021. Kết quả: Có 126 bệnh nhân, tuổi trung bình 60,6 ± 11,1 tuổi. 15,9% ung thư 1/3 trên dạ dày và 81,7% là 1/3 giữa. Ung thư ở giai đoạn I, II, III là 19,0%, 49,2%, 31,7%. 71,4% PTNS hoàn toàn cắt TBDD và nối lưu thông tiêu hóa bằng máy cắt nối thẳng. 3,2% trường hợp có tai biến trong mổ và 2,4% có biến chứng sau mổ, không có trường hợp nào tử vong. Số hạch nạo vét được trung bình 22,06 ± 7,6 hạch, lượng máu mất trung bình là 32,14 ± 10,4 ml, thời gian phẫu thuật trung bình là 210,4 ± 34,3 phút, thời gian nằm viện trung bình là 8,3 ± 2,5 ngày và thời gian sống thêm toàn bộ sau mổ trung bình là 36,9 ± 2,25 tháng. Kết luận: PTNS cắt TBDD là kỹ thuật an toàn và hiệu quả trong điều trị UTDD, nối thực quản hỗng tràng bằng máy cắt nối thẳng không cắt thực quản và hỗng tràng trước là kỹ thuật an toàn, tiết kiệm. Từ khóa: Kỹ thuật phẫu thuật nội soi dạ dày, ung thư dạ dày. ABSTRACT EXPERIENCE IN 126 PATIENTS OF LAPAROSCOPIC TOTAL GASTRECTOMY FOR THE TREATMENT OF GASTRIC CANCER Background: The goal of this study was to report on the experience of laparoscopic total gastrectomy (LTG) in 126 patients with gastric cancer Materials and Methods: Retrospective descriptive study of 126 patients who underwent LTG for gastric cancer between 2014 and May 2021. Results: Mean age 60,6 ± 11,1; gastric cancer at stage I, II, III was 19,0%, 49,2%, 31,7% respectively. 71,4% patients underwent totally LTG and functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum. 3.2% of cases had complications during surgery and 2,4% of cases had complications after surgery. There was no postoperative deaths. The average number of dredged lymph nodes was 22.06 ± 7.6 lymph nodes. The mean blood loss was 32.14 ± 10.4 ml. The mean operative time was 210.4 ± 34.3 minutes. The mean time for beginning oral feeding was 4.4 ± 1.9 days. The mean hospital stay was 8.3 ± 2.5 days. The mean overall survival was 36.9 ± 2,25 months. Conclusions: LTG is a safe and effective technique for the treatment of gastric cancer. The technique functional end-to-end esophagojejunostomy by linear stapler without previous resection of esophagus and jejunum was safe and saving. Keywords: Technique of laparoscopic gastrectomy, gastric cancer

scholarly journals Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Manash Ranjan Sahoo ◽  
Satyajit Samal ◽  
Jyotirmay Nayak
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Total Gastrectomy ◽  
Median Time ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Care Hospital ◽  
Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

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