Abstract
Background
This study depicts a novel reconstruction method of self-pulling and latter transection (SPLT) in totally laparoscopic total gastrectomy (TLTG) and evaluates its feasibility and short-term safety by comparing its surgical and postoperative outcomes with the conventional TLTG.
Patients and methods
Forty patients with gastric cancer from June 2014 to December 2015 received SPLT-TLTG. Data of clinicopathologic characteristics, surgical and postoperative outcomes, and follow-up findings in SPLT cases were collected and retrospectively compared with those of conventional TLTG to clarify the clinical benefits.
Results
The mean duration of the operation was 179.5 ± 37.7 min in SPLT-TLTG, including 23.2 ± 8.8 min of reconstruction; both were significantly shorter than the conventional TLTG (P = 0.030; P < 0.001). There were no significant differences in blood loss, time of the first flatus and postoperative hospital stays between two groups. SPLT-TLTG developed no complication beyond the conventional TLTG.
Conclusion
SPLT-TLTG is safe, feasible and minimally invasive. It may serve as a promising procedure for gastric cancer that helps to expand the indication of TLTG to cases with even high level of tumor invasion and requires less in both surgical skills and clinical costs.
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References
Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. J Clin Oncol 32:627–633
Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, JCOG Gastric Cancer Surgical Study Group (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244
Wada N, Kurokawa Y, Takiguchi S, Takahashi T, Yamasaki M, Miyata H, Nakajima K, Mori M, Doki Y (2014) Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric Cancer 17:137–140
Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357
Hu Y, Ying M, Huang C, Wei H, Jiang Z, Peng X, Hu J, Du X, Wang B, Lin F, Xu J, Dong G, Mou T, Li G, Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) Group (2014) Oncologic outcomes of laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective cohort study from China. Surg Endosc 28:2048–2056
Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J, Inaba K, Yanaga K, Uyama I (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27:286–294
Uyama I, Suda K, Satoh S (2013) Laparoscopic surgery for advanced gastric cancer: current status and future perspectives. J Gastric Cancer 13:19–25
Lee JH, Son SY, Lee CM, Ahn SH, Park DJ, Kim HH (2013) Morbidity and mortality after laparoscopic gastrectomy for advanced gastric cancer: results of a phase II clinical trial. Surg Endosc 27:2877–2885
Nakauchi M, Suda K, Kadoya S, Inaba K, Ishida Y, Uyama I (2016) Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc 30:4632–4639
Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama I (2011) The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer 14:365–371
Chen K, Mou YP, Xu XW, Pan Y, Zhou YC, Cai JQ, Huang CJ (2015) Comparison of short-term surgical outcomes between totally laparoscopic and laparoscopic-assisted distal gastrectomy for gastric cancer: a 10-y single-center experience with meta-analysis. J Surg Res 194:367–374
Hiyoshi Y, Oki E, Ando K, Ito S, Saeki H, Morita M, Baba H, Maehara Y (2014) Outcome of esophagojejunostomy during totally laparoscopic total gastrectomy: a single-center retrospective study. Anticancer Res 34:7227–7232
Okabe H, Obama K, Tanaka E, Nomura A, Kawamura J, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23:2167–2171
Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T, Akiyama Y, Wakabayashi G (2015) Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg 38:102–112
Yang HK, Suh YS, Lee HJ (2013) Minimally invasive approaches for gastric cancer-Korean experience. J Surg Oncol 107:277–281
Kim MG, Kim KC, Yook JH, Kim BS, Kim TH, Kim BS (2011) A practical way to overcome the learning period of laparoscopic gastrectomy for gastric cancer. Surg Endosc 25:3838–3844
So KO, Park JM (2011) Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer 11:206–211
Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259:109–116
Bracale U, Marzano E, Nastro P, Barone M, Cuccurullo D, Cutini G, Corcione F, Pignata G (2010) Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: a multicenter study. Surg Endosc 24:2475–2479
Kinoshita T, Oshiro T, Ito K, Shibasaki H, Okazumi S, Katoh R (2010) Intracorporeal circular-stapled esophagojejunostomy using hand-sewn purse-string suture after laparoscopic total gastrectomy. Surg Endosc 24:2908–2912
Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, Uyama I (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211:25–29
Nagai E, Ohuchida K, Nakata K, Miyasaka Y, Maeyama R, Toma H, Shimizu S, Tanaka M (2013) Feasibility and safety of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy: inverted T-shaped anastomosis using linear staplers. Surgery 153:732–738
Du J, Shuang J, Li J, Li J, Hua J (2014) Intracorporeal circular-stapled esophagojejunostomy after laparoscopic total gastrectomy: a novel self-pulling and holding purse-string suture technique. J Am Coll Surg 218:67–72
Ebihara Y, Okushiba S, Kawarada Y, Kitashiro S, Katoh H (2013) Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy. Langenbecks Arch Surg 398:475–479
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Drs. Jun Hong, Ya-Ping Wang, Jian Wang, Yi-bing Bei, Lu-Chun Hua and Han-Kun Hao have no conflicts of interest or financial ties to disclose.
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Hong, J., Wang, YP., Wang, J. et al. A novel method of self-pulling and latter transected reconstruction in totally laparoscopic total gastrectomy: feasibility and short-term safety. Surg Endosc 31, 2968–2976 (2017). https://doi.org/10.1007/s00464-016-5314-y
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DOI: https://doi.org/10.1007/s00464-016-5314-y