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, 房静远.根除幽门螺杆菌预防胃癌的影响因素研究进展.中华消化杂志, 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.	黄玉琴, 王森, 汤东, 等.非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治性切除术中的应用.中华消化外科杂志, 2016, 15(3):247-252.
4.	高波, 董剑宏.三角吻合术在全腹腔镜远端胃癌根治术后消化道重建中的应用价值.中华消化外科杂志, 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.	朱志强, 姚寒晖, 吴杨, 等.三角吻合术在全腹腔镜远端胃癌根治消化道重建中的应用.安徽医科大学学报, 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, 杨清水, 等.快速康复外科对腹腔镜辅助远端胃癌根治术的应激影响.南昌大学学报:医学版, 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.	罗运生, 夏涛, 李威.腹腔镜辅助行Ⅱ/Ⅲ期胃癌根治术临床分析.中国普通外科杂志, 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.	石彦, 余佩武, 钱锋, 等.腹腔镜根治性全胃或近端胃切除后食管抵钉座置入新技术.中华消化外科杂志, 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, 郑民华, 薛佩, 等.完全腹腔镜根治性全胃切除术后食管空肠三角吻合的近期疗效.中华消化外科杂志, 2014, 13(2):134-138.
18.	黄昌明, 林建贤, 郑朝辉, 等.三角吻合技术在全腹腔镜下胃远端癌根治术中的应用.中华胃肠外科杂志, 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.	严超, 燕敏, 朱正伦, 等.胃十二指肠三角吻合术应用于胃癌全腹腔镜下远端胃切除术的可行性研究.中华胃肠外科杂志, 2014, 71(5):438-443.
21.	李红浪, 王君辅, 李昌荣.腹腔镜远端胃癌根治术腹腔内与腹腔外胃十二指肠吻合术早期疗效比较的meta分析.中国内镜杂志, 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, 赵新泰. 314例中国胃癌患者K-ras基因的突变状态分析.国际检验医学杂志, 2015, 36(24):3514-3517.
24.	涂建成, 方健, 周亮, 等.三角吻合术在胃癌患者腹腔镜下远端胃切除术中的应用.临床和实验医学杂志, 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, 王丽丽, 杨琼, 等. pT3N0M0期胸段食管鳞癌胸腹两野根治术后的复发模式.中华肿瘤杂志, 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, 房静远.根除幽门螺杆菌预防胃癌的影响因素研究进展.中华消化杂志, 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. 黄玉琴, 王森, 汤东, 等.非离断式Roux-en-Y吻合在腹腔镜远端胃癌根治性切除术中的应用.中华消化外科杂志, 2016, 15(3):247-252.
4. 高波, 董剑宏.三角吻合术在全腹腔镜远端胃癌根治术后消化道重建中的应用价值.中华消化外科杂志, 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. 朱志强, 姚寒晖, 吴杨, 等.三角吻合术在全腹腔镜远端胃癌根治消化道重建中的应用.安徽医科大学学报, 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, 杨清水, 等.快速康复外科对腹腔镜辅助远端胃癌根治术的应激影响.南昌大学学报:医学版, 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. 罗运生, 夏涛, 李威.腹腔镜辅助行Ⅱ/Ⅲ期胃癌根治术临床分析.中国普通外科杂志, 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. 石彦, 余佩武, 钱锋, 等.腹腔镜根治性全胃或近端胃切除后食管抵钉座置入新技术.中华消化外科杂志, 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, 郑民华, 薛佩, 等.完全腹腔镜根治性全胃切除术后食管空肠三角吻合的近期疗效.中华消化外科杂志, 2014, 13(2):134-138.
18. 黄昌明, 林建贤, 郑朝辉, 等.三角吻合技术在全腹腔镜下胃远端癌根治术中的应用.中华胃肠外科杂志, 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. 严超, 燕敏, 朱正伦, 等.胃十二指肠三角吻合术应用于胃癌全腹腔镜下远端胃切除术的可行性研究.中华胃肠外科杂志, 2014, 71(5):438-443.
21. 李红浪, 王君辅, 李昌荣.腹腔镜远端胃癌根治术腹腔内与腹腔外胃十二指肠吻合术早期疗效比较的meta分析.中国内镜杂志, 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, 赵新泰. 314例中国胃癌患者K-ras基因的突变状态分析.国际检验医学杂志, 2015, 36(24):3514-3517.
24. 涂建成, 方健, 周亮, 等.三角吻合术在胃癌患者腹腔镜下远端胃切除术中的应用.临床和实验医学杂志, 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, 王丽丽, 杨琼, 等. pT3N0M0期胸段食管鳞癌胸腹两野根治术后的复发模式.中华肿瘤杂志, 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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