Application of <b>π-</b>shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GONG Shuai , ZHANG Pengbo , ZHANG Chong , WU Nai , ZHANG Yi , MA Yudong , DU Mingnan , REN Zeqiang ,  ZHANG Xiuzhong

Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P. R. China;

Corresponding?author：

ZHANG Xiuzhong, Email: 13776780677@163.com

Keywords：

stomach neoplasm; laparoscope; total gastrectomy; π-shaped esophagojejunal anastomosis

DOI：

10.7507/1007-9424.202012049

Video：

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Objective To explore feasibility and safety of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy (TLTG).Method The clinical data of 20 patients who underwent TLTG, admitted in the Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018 were retrospectively analyzed.Results TLTG with π-shaped esophagojejunal anastomosis was successfully carried out in all 20 patients. The operative time was (236.0±55.5) min, the π-shaped esophagojejunal anastomosis time was (25.7±4.8) min, the intraoperative blood loss was (192.0±148.9) mL, the operative incision length was (3.7±0.8) cm. The postoperative pain score was 2.4±1.1, the first flatus time was (3.1±0.9) d, the first postoperative ambulation time was (1.8±0.7) d, the removal time of nasoenteral nutrution tube was (7.4±2.4) d, the liquid diet time was (6.2±1.4) d, the removal time of intraoabdominal drainage tube was (7.8±2.8) d, the postoperative hospital stay was (10.8±3.0) d. There was no death related to the anastomosis in all patients. Two patients developed a little pleural effusion and 1 patient developed lymphatic leakage were cured with conservative treatment. One patient with intraabdominal encapsulated effusion was cured by puncture and drainage treating. There was no postive incisal margin. The length of upper segment of resection form gastric cancer was (2.3±1.7) cm, the maximum tumor diameter was (4.9±2.8) cm, the number of dissected lymph nodes was 27.9±5.6. All patients were followed up 3–15 months. Eight patients underwent endoscopic examination had no obvious anastomosis stenosis and esophageal reflux. Two patients died of tumor recurrence and metastasis witnin one year after operation, and the rest had disease-free survival until the end of follow-up.Conclusion From preliminary results of limited cases in this study, π-shaped esophagojejunal anastomosis in TLTG is a technically safe and feasible surgical procedure in treatment of gastric cancer.

Citation： GONG Shuai, ZHANG Pengbo, ZHANG Chong, WU Nai, ZHANG Yi, MA Yudong, DU Mingnan, REN Zeqiang, ZHANG Xiuzhong. Application of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(9): 1188-1192. doi: 10.7507/1007-9424.202012049 Copy

1.	Jung KW, Won YJ, Kong HJ, et al. Cancer statistics in Korea: Incidence, mortality, survival, and prevalence in 2016. Cancer Res Treat, 2019, 51(2): 417-430.
2.	Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3.	Katai H, Ishikawa T, Akazawa K, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100 000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer, 2018, 21(1): 144-154.
4.	胡建昆, 趙林勇, 陳心足. 3D腹腔鏡胃癌根治術的應用及前景. 中國普外基礎與臨床雜志, 2016, 23(8): 901-904.
5.	Kwon IG, Son YG, Ryu SW. Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: π-shaped esophagojejunostomy, 3-in-1 technique. J Am Coll Surg, 2016, 223(3): e25-e29.
6.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
7.	Yu J, Huang C, Sun Y, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: The CLASS-01 randomized clinical trial. JAMA, 2019, 321(20): 1983-1992.
8.	Lin JX, Huang CM, Zheng CH, et al. Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy. Surg Endosc, 2016, 30(5): 1988-1998.
9.	Katai H, Mizusawa J, Katayama H, et al. Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage Ⅰ gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer, 2019, 22(5): 999-1008.
10.	Hyung WJ, Yang HK, Han SU, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage Ⅰ gastric cancer: a prospective multi-center phase Ⅱ clinical trial, KLASS 03. Gastric Cancer, 2019, 22(1): 214-222.
11.	汪未知, 呂嘉倫, 徐澤寬. 腔鏡食管胃結合部癌消化道重建方式的選擇. 中國普外基礎與臨床雜志, 2019, 26(9): 1030-1034.
12.	龔帥, 張蓬波, 張秀忠, 等. OrVil吻合技術在腹腔鏡賁門癌手術中的應用. 中華普通外科雜志, 2016, 31(8): 639-642.
13.	Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc, 2009, 23(11): 2624-2630.
14.	所劍. 全腹腔鏡全胃切除術消化道重建方式選擇—圓形還是側側吻合? 中國實用外科雜志, 2016, 36(9): 955-957.
15.	楊力, 徐澤寬, 徐皓, 等. 胃癌全腹腔鏡下全胃切除食管空腸π形吻合臨床體會. 中華胃腸外科雜志, 2016, 19(8): 948-950.
16.	劉洋, 張忠濤, 孟化. 食管空腸π形Roux-en-Y吻合術在全腹腔鏡全胃切除術中的應用價值. 中華消化外科雜志, 2018, 17(6): 626-630.
17.	楊力, 徐澤寬, 徐皓, 等. 食管空腸π吻合在全腹腔鏡全胃切除術中的應用價值. 中華消化外科雜志, 2017, 16(5): 522-526.
18.	黃玉琴, 湯東, 王偉, 等. 食管空腸反π吻合在腹腔鏡全胃切除術中的應用價值. 中華消化外科雜志, 2017, 16(6): 619-623.

1. Jung KW, Won YJ, Kong HJ, et al. Cancer statistics in Korea: Incidence, mortality, survival, and prevalence in 2016. Cancer Res Treat, 2019, 51(2): 417-430.
2. Chen W, Zheng R, Baade PD, et al. Cancer statistics in China, 2015. CA Cancer J Clin, 2016, 66(2): 115-132.
3. Katai H, Ishikawa T, Akazawa K, et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100 000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer, 2018, 21(1): 144-154.
4. 胡建昆, 趙林勇, 陳心足. 3D腹腔鏡胃癌根治術的應用及前景. 中國普外基礎與臨床雜志, 2016, 23(8): 901-904.
5. Kwon IG, Son YG, Ryu SW. Novel intracorporeal esophagojejunostomy using linear staplers during laparoscopic total gastrectomy: π-shaped esophagojejunostomy, 3-in-1 technique. J Am Coll Surg, 2016, 223(3): e25-e29.
6. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
7. Yu J, Huang C, Sun Y, et al. Effect of laparoscopic vs open distal gastrectomy on 3-year disease-free survival in patients with locally advanced gastric cancer: The CLASS-01 randomized clinical trial. JAMA, 2019, 321(20): 1983-1992.
8. Lin JX, Huang CM, Zheng CH, et al. Evaluation of laparoscopic total gastrectomy for advanced gastric cancer: results of a comparison with laparoscopic distal gastrectomy. Surg Endosc, 2016, 30(5): 1988-1998.
9. Katai H, Mizusawa J, Katayama H, et al. Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage Ⅰ gastric cancer: Japan Clinical Oncology Group study JCOG1401. Gastric Cancer, 2019, 22(5): 999-1008.
10. Hyung WJ, Yang HK, Han SU, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage Ⅰ gastric cancer: a prospective multi-center phase Ⅱ clinical trial, KLASS 03. Gastric Cancer, 2019, 22(1): 214-222.
11. 汪未知, 呂嘉倫, 徐澤寬. 腔鏡食管胃結合部癌消化道重建方式的選擇. 中國普外基礎與臨床雜志, 2019, 26(9): 1030-1034.
12. 龔帥, 張蓬波, 張秀忠, 等. OrVil吻合技術在腹腔鏡賁門癌手術中的應用. 中華普通外科雜志, 2016, 31(8): 639-642.
13. Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc, 2009, 23(11): 2624-2630.
14. 所劍. 全腹腔鏡全胃切除術消化道重建方式選擇—圓形還是側側吻合? 中國實用外科雜志, 2016, 36(9): 955-957.
15. 楊力, 徐澤寬, 徐皓, 等. 胃癌全腹腔鏡下全胃切除食管空腸π形吻合臨床體會. 中華胃腸外科雜志, 2016, 19(8): 948-950.
16. 劉洋, 張忠濤, 孟化. 食管空腸π形Roux-en-Y吻合術在全腹腔鏡全胃切除術中的應用價值. 中華消化外科雜志, 2018, 17(6): 626-630.
17. 楊力, 徐澤寬, 徐皓, 等. 食管空腸π吻合在全腹腔鏡全胃切除術中的應用價值. 中華消化外科雜志, 2017, 16(5): 522-526.
18. 黃玉琴, 湯東, 王偉, 等. 食管空腸反π吻合在腹腔鏡全胃切除術中的應用價值. 中華消化外科雜志, 2017, 16(6): 619-623.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of π-shaped esophagojejunal anastomosis in totally laparoscopic total gastrectomy

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