Feasibility Discussion of Delta-Shaped Gastroduodenostomy During Totally Laparoscopic Distal Gastrectomy in Treatment of Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANGRu-gao , LIANLi-zhi , ZHANGJia-wen

Department of General Surgery, The First People's Hospital of Xiaogan, Xiaogan 432000, Hubei Province, China;

Corresponding?author：

YANGRu-gao, Email: 2992792296@qq.com

Keywords：

Gastric cancer; Delta-shaped gastroduodenostomy; Distal gastrectomy; Laparoscopy

DOI：

10.7507/1007-9424.20160374

Video：

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Objective To investigate the feasibility of totally laparoscopic distal gastrectomy (TLDG) based on delta-shaped gastroduodenostomy in the treatment of gastric cancer. Methods Ninety patients with gastric cancer who treated in our hospital from December 2013 to December 2015 were retrospectively analyzed. Forty-five patients with gastric cancer received delta-shaped gastroduodenostomy by using laparoscopic linear stapler after they were treated with TLDG and D2 lymphadenectomy (TLDG group), while 45 patients with gastric cancer received laparoscopic assisted distal gastrectomy (LADG) and D2 lymphadenectomy (LADG group). The operative time, digestive tract reconstruction time, blood loss, number of dissected lymph nodes, length of proximal and distal margin to the cancer, time of the first flatus, recovery time of drinking water, time of resuming semi-fluid diet, postoperative hospital stay, and complications during follow-up period were observed and evaluated. Results ① Intraoperative findings. The operative time, digestive tract reconstruction time, and length of distal margin to the cancer of TLDG group were significantly longer than those corresponding index of LADG group (P < 0.050), but the blood loss was significantly less than that of LADG group (P < 0.050). There was no significant difference between two groups in proximal margin to the cancer and number of dissected lymph nodes (P > 0.050). ② Postoperative findings. There was no significant difference between two groups in time of the first flatus, recovery time of drinking water, time of resuming semi-fluid diet, postoperative hospital stay, and incidence of complication (P > 0.050). All patients were followed for 6-16 months (median with 10 months), and there was no one suffered from recurrence, anastomotic stricture, and anastomotic obstruction. Conclusion The TLDG based on delta-shaped gastroduodenostomy in the treatment of gastric cancer was feasible and safe, and it will be an ideal method for digestive tract reconstruction in patients with gastric cancer, so it is worthy to clinical application.

Citation： YANGRu-gao, LIANLi-zhi, ZHANGJia-wen. Feasibility Discussion of Delta-Shaped Gastroduodenostomy During Totally Laparoscopic Distal Gastrectomy in Treatment of Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1483-1487. doi: 10.7507/1007-9424.20160374 Copy

1.	虞思祎, 房靜遠.根除幽門螺桿菌預防胃癌的影響因素研究進展.中華消化雜志, 2016, 75(1):568-570.
2.	Calvin DL, Rohan AJ, Nilson S, et al. Use of a magnetically coupled camera and novel mini laparoscopic instruments to perform minimally invasive sigmoid colon resection. Gastroenterology, 2011, 140(5):998-1001.
3.	黃玉琴, 王森, 湯東, 等.非離斷式Roux-en-Y吻合在腹腔鏡遠端胃癌根治性切除術中的應用.中華消化外科雜志, 2016, 15(3):247-252.
4.	高波, 董劍宏.三角吻合術在全腹腔鏡遠端胃癌根治術后消化道重建中的應用價值.中華消化外科雜志, 2016, 15(3):748-751.
5.	Carbonell M. Minimally invasive gastric surgery. Surg Clin North Am, 2011, 91(5):1089-1103.
6.	Rostas JW 3rd, Mai TT, Richards WO. Gastric motility physiology and surgical intervention. Surg Clin North Am, 2011, 91(5):983-999.
7.	Ahn SH, Son SY, Lee CM, et al. Intracorporeal uncut Roux-en-Y gastrojejunostomy reconstruction in pure single-incision laparos-copic distal gastrectomy for early gastric cancer:unaided stapling closure. J Am Coll Surg, 2014, 218(1):e17-e21.
8.	UICC International Union Against Cancer. TNM classification of malignant tumors. 7th ed, Springer-Verlag:Heidelberg, 2009:122-135.
9.	朱志強, 姚寒暉, 吳楊, 等.三角吻合術在全腹腔鏡遠端胃癌根治消化道重建中的應用.安徽醫科大學學報, 2013, 12(11):1410-1412.
10.	Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic Billroth Ⅰ gastrectomy:new technique of intraa-bdominal gastroduodenostomy. J Am Coll Surg, 2002, 195(2):284-287.
11.	廖信芳, 李柱, 楊清水, 等.快速康復外科對腹腔鏡輔助遠端胃癌根治術的應激影響.南昌大學學報:醫學版, 2016, 56(2):658-661.
12.	Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology, 2012, 143(4):897-912.
13.	羅運生, 夏濤, 李威.腹腔鏡輔助行Ⅱ/Ⅲ期胃癌根治術臨床分析.中國普通外科雜志, 2013, 22(4):509-511.
14.	Zhao EH, Ling TL, Cao H. Current status of surgical treatment of gastric cancer in the era of minimally invasive surgery in China:opportunity and challenge. Int J Surg, 2016, 28(4):45-50.
15.	石彥, 余佩武, 錢鋒, 等.腹腔鏡根治性全胃或近端胃切除后食管抵釘座置入新技術.中華消化外科雜志, 2012, 11(1):82-85.
16.	Kim HI, Woo Y, Hyung WJ. Laparoscopic distal gastrectomy with an intracorporeal gastroduodenostomy using a circular stapler. J Am Coll Surg, 2012, 214(1):e7-e13.
17.	臧潞, 鄭民華, 薛佩, 等.完全腹腔鏡根治性全胃切除術后食管空腸三角吻合的近期療效.中華消化外科雜志, 2014, 13(2):134-138.
18.	黃昌明, 林建賢, 鄭朝輝, 等.三角吻合技術在全腹腔鏡下胃遠端癌根治術中的應用.中華胃腸外科雜志, 2013, 16(2):140-143.
19.	Chen K, Mou YP, Xu XW, et al. 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, 2015, 194(2):367-374.
20.	嚴超, 燕敏, 朱正倫, 等.胃十二指腸三角吻合術應用于胃癌全腹腔鏡下遠端胃切除術的可行性研究.中華胃腸外科雜志, 2014, 71(5):438-443.
21.	李紅浪, 王君輔, 李昌榮.腹腔鏡遠端胃癌根治術腹腔內與腹腔外胃十二指腸吻合術早期療效比較的meta分析.中國內鏡雜志, 2014, 20(12):1248-1254.
22.	Iwatsuki M, Tanaka H, Shimizu K, et al. Simultaneous total laparos-copic curative resection for synchronous gastric, cecal and rectal cancer:report of a case. Int J Surg Case Rep, 2015, 6C:129-132.
23.	彭南求, 趙新泰. 314例中國胃癌患者K-ras基因的突變狀態分析.國際檢驗醫學雜志, 2015, 36(24):3514-3517.
24.	涂建成, 方健, 周亮, 等.三角吻合術在胃癌患者腹腔鏡下遠端胃切除術中的應用.臨床和實驗醫學雜志, 2015, 55(17):1458-1460.
25.	Patricia S, Samantha JP, May W. Laparoscopic rectosigmoid resection with transvaginal rectopexy and extraction for rectal prolapse. Gastroenterology, 2011, 140(5):879-883.
26.	Lee SW, Nomura E, Tokuhara T, et al. Laparoscopic technique and initial experience with knotless, unidirectional barbed suture closure for staple-conserving, delta-shaped gastroduodenostomy after distal gastrectomy. J Am Coll Surg, 2011, 213(6):e39-e45.
27.	王玉祥, 王麗麗, 楊瓊, 等. pT3N0M0期胸段食管鱗癌胸腹兩野根治術后的復發模式.中華腫瘤雜志, 2016, 38(1):788-790.
28.	Kim BS, Yook JH, Choi YB, et al. Comparison of early outcomes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A, 2011, 21(5):387-391.
29.	Noshiro H, Iwasaki H, Miyasaka Y, et al. An additional suture secures against pitfalls in delta-shaped gastroduodenostomy after laparoscopic distal gastrectomy. Gastric Cancer, 2011, 14(4):385-389.
30.	Kanaya S, Kawamura Y, Kawada H, et al. The delta-shaped anastomosis in laparoscopic distal gastrectomy:analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer, 2011, 14(4):365-371.

1. 虞思祎, 房靜遠.根除幽門螺桿菌預防胃癌的影響因素研究進展.中華消化雜志, 2016, 75(1):568-570.
2. Calvin DL, Rohan AJ, Nilson S, et al. Use of a magnetically coupled camera and novel mini laparoscopic instruments to perform minimally invasive sigmoid colon resection. Gastroenterology, 2011, 140(5):998-1001.
3. 黃玉琴, 王森, 湯東, 等.非離斷式Roux-en-Y吻合在腹腔鏡遠端胃癌根治性切除術中的應用.中華消化外科雜志, 2016, 15(3):247-252.
4. 高波, 董劍宏.三角吻合術在全腹腔鏡遠端胃癌根治術后消化道重建中的應用價值.中華消化外科雜志, 2016, 15(3):748-751.
5. Carbonell M. Minimally invasive gastric surgery. Surg Clin North Am, 2011, 91(5):1089-1103.
6. Rostas JW 3rd, Mai TT, Richards WO. Gastric motility physiology and surgical intervention. Surg Clin North Am, 2011, 91(5):983-999.
7. Ahn SH, Son SY, Lee CM, et al. Intracorporeal uncut Roux-en-Y gastrojejunostomy reconstruction in pure single-incision laparos-copic distal gastrectomy for early gastric cancer:unaided stapling closure. J Am Coll Surg, 2014, 218(1):e17-e21.
8. UICC International Union Against Cancer. TNM classification of malignant tumors. 7th ed, Springer-Verlag:Heidelberg, 2009:122-135.
9. 朱志強, 姚寒暉, 吳楊, 等.三角吻合術在全腹腔鏡遠端胃癌根治消化道重建中的應用.安徽醫科大學學報, 2013, 12(11):1410-1412.
10. Kanaya S, Gomi T, Momoi H, et al. Delta-shaped anastomosis in totally laparoscopic Billroth Ⅰ gastrectomy:new technique of intraa-bdominal gastroduodenostomy. J Am Coll Surg, 2002, 195(2):284-287.
11. 廖信芳, 李柱, 楊清水, 等.快速康復外科對腹腔鏡輔助遠端胃癌根治術的應激影響.南昌大學學報:醫學版, 2016, 56(2):658-661.
12. Bradley D, Magkos F, Klein S. Effects of bariatric surgery on glucose homeostasis and type 2 diabetes. Gastroenterology, 2012, 143(4):897-912.
13. 羅運生, 夏濤, 李威.腹腔鏡輔助行Ⅱ/Ⅲ期胃癌根治術臨床分析.中國普通外科雜志, 2013, 22(4):509-511.
14. Zhao EH, Ling TL, Cao H. Current status of surgical treatment of gastric cancer in the era of minimally invasive surgery in China:opportunity and challenge. Int J Surg, 2016, 28(4):45-50.
15. 石彥, 余佩武, 錢鋒, 等.腹腔鏡根治性全胃或近端胃切除后食管抵釘座置入新技術.中華消化外科雜志, 2012, 11(1):82-85.
16. Kim HI, Woo Y, Hyung WJ. Laparoscopic distal gastrectomy with an intracorporeal gastroduodenostomy using a circular stapler. J Am Coll Surg, 2012, 214(1):e7-e13.
17. 臧潞, 鄭民華, 薛佩, 等.完全腹腔鏡根治性全胃切除術后食管空腸三角吻合的近期療效.中華消化外科雜志, 2014, 13(2):134-138.
18. 黃昌明, 林建賢, 鄭朝輝, 等.三角吻合技術在全腹腔鏡下胃遠端癌根治術中的應用.中華胃腸外科雜志, 2013, 16(2):140-143.
19. Chen K, Mou YP, Xu XW, et al. 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, 2015, 194(2):367-374.
20. 嚴超, 燕敏, 朱正倫, 等.胃十二指腸三角吻合術應用于胃癌全腹腔鏡下遠端胃切除術的可行性研究.中華胃腸外科雜志, 2014, 71(5):438-443.
21. 李紅浪, 王君輔, 李昌榮.腹腔鏡遠端胃癌根治術腹腔內與腹腔外胃十二指腸吻合術早期療效比較的meta分析.中國內鏡雜志, 2014, 20(12):1248-1254.
22. Iwatsuki M, Tanaka H, Shimizu K, et al. Simultaneous total laparos-copic curative resection for synchronous gastric, cecal and rectal cancer:report of a case. Int J Surg Case Rep, 2015, 6C:129-132.
23. 彭南求, 趙新泰. 314例中國胃癌患者K-ras基因的突變狀態分析.國際檢驗醫學雜志, 2015, 36(24):3514-3517.
24. 涂建成, 方健, 周亮, 等.三角吻合術在胃癌患者腹腔鏡下遠端胃切除術中的應用.臨床和實驗醫學雜志, 2015, 55(17):1458-1460.
25. Patricia S, Samantha JP, May W. Laparoscopic rectosigmoid resection with transvaginal rectopexy and extraction for rectal prolapse. Gastroenterology, 2011, 140(5):879-883.
26. Lee SW, Nomura E, Tokuhara T, et al. Laparoscopic technique and initial experience with knotless, unidirectional barbed suture closure for staple-conserving, delta-shaped gastroduodenostomy after distal gastrectomy. J Am Coll Surg, 2011, 213(6):e39-e45.
27. 王玉祥, 王麗麗, 楊瓊, 等. pT3N0M0期胸段食管鱗癌胸腹兩野根治術后的復發模式.中華腫瘤雜志, 2016, 38(1):788-790.
28. Kim BS, Yook JH, Choi YB, et al. Comparison of early outcomes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A, 2011, 21(5):387-391.
29. Noshiro H, Iwasaki H, Miyasaka Y, et al. An additional suture secures against pitfalls in delta-shaped gastroduodenostomy after laparoscopic distal gastrectomy. Gastric Cancer, 2011, 14(4):385-389.
30. Kanaya S, Kawamura Y, Kawada H, et al. The delta-shaped anastomosis in laparoscopic distal gastrectomy:analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer, 2011, 14(4):365-371.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Feasibility Discussion of Delta-Shaped Gastroduodenostomy During Totally Laparoscopic Distal Gastrectomy in Treatment of Gastric Cancer

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