Application of Arch-Preserved Jejunum in Total Gastrectomy with Roux-en-Y Esophagojejunostomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Xinzu , ZHANG Weihan , WU Bin , ZHANG Bo , CHEN Zhixin , CHEN Jiaping , ZHOU Zongguang ,  HU Jiankun

Department of Gastrointestinal Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province，China;

Corresponding author：

HU Jiankun, Email: hujkwch@126.com

Keywords：

Arch-preserved jejunum; Adenocarcinoma of esophagogastric junction; Upper-middle stomach cancer; Total gastrectomy; Roux-en-Y esophagojejunostomy

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Objective 　To explore the feasibility of arch-preserved jejunum in total gastrectomy with Roux-en-Y esophagojejunostomy for adenocarcinoma of esophagogastric junction （AEG） and upper-middle gastric cancer.
Methods　 Clinical data of 13 patients who underwent total gastrectomy with Roux-en-Y esophagojejunostomy with usage of arch-preserved jejunum to resolve the anastomosis tension problem in our hospital from Dec. 2012 to Apr. 2013 were analyzed
retrospectively， and surgical experience was summarized.
Results 　The maximal and actual extended lengths were （7.75±1.75） cm （4-10 cm） and （5.95±1.82） cm （3-9 cm） respectively， with the utilization percentage of （77.91±16.60）% （50.0%-100.0%）. These patients hadn’t suffered postoperative mortality and severe complications， such as anastomosis leakage， stenosis， hemorrhage， and so on. Besides， there were 1 case complicated with postoperative acute urinary retention and another 1 case complicated with infra-hepatic space abscess and peritoneal infection.
Conclusion 　Arch-preserved jejunum is a practical surgical technique to handle with the anastomosis tension of esophagojejunostomy in total gastrectomy for AEG and upper-middle gastric cancer.

Citation： CHEN Xinzu,ZHANG Weihan,WU Bin,ZHANG Bo,CHEN Zhixin,CHEN Jiaping,ZHOU Zongguang,HU Jiankun,.. Application of Arch-Preserved Jejunum in Total Gastrectomy with Roux-en-Y Esophagojejunostomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(6): 600-603. doi: Copy

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3.	Yang L. Incidence and mortality of gastric cancer in China[J]. World J Gastroenterol， 2006， 12(1)：17-20.
4.	Wen L， Chen XZ， Wu B， et al. Total vs. proximal gastrectomy for proximal gastric cancer：a systematic review and meta-analysis[J]. Hepatogastroenterology， 2012， 59(114)：633-640.
5.	Huang Q. Carcinoma of the gastroesophageal junction in Chinese patients[J]. World J Gastroenterol， 2012， 18(48)：7134-7140.
6.	Huang Q， Fan X， Agoston AT， et al. Comparison of gastro-oesophageal junction carcinomas in Chinese versus American patients[J]. Histopathology， 2011， 59(2)：188-197.
7.	Wang K， Yang CQ， Duan LP， et al. Changing pattern of adeno-carcinoma of the esophagogastric junction in recent 10 years：experience at a large tertiary medical center in China[J]. Tumori，.
8.	胡建昆，陈心足. 进展期胃癌治疗方式合理选择及评价[J]. 中国实用外科杂志， 2011， 31(8)：720-722.
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13.	Siewert JR， Stein HJ， Sendler A， et al. Surgical resection for cancer of the cardia[J]. Semin Surg Oncol， 1999， 17(2)：125-131.
14.	Stein HJ， Feith M， Siewert JR. Cancer of the esophagogastric junction[J]. Surg Oncol， 2000， 9(1)：35-41.
15.	代斌，潘琳，杨晨，等. 食管胃结合部腺癌病人行近端与全胃切除术后生活质量比较[J]. 中国实用外科杂志， 2011， 31(2)：147-149.
16.	Sasako M， Sano T， Yamamoto S， et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia：a randomised controlled trial[J]. Lancet Oncol， 2006， 7(8)：644-651.
17.	Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3)[J]. Gastric Cancer， 2011， 14(2)：113-123.
18.	胡建昆，陈心足. 胃癌手术消化道重建方式的选择及评价[J]. 中华消化外科杂志， 2013， 12(1)：25-29.
19.	Ito H， Inoue H， Odaka N， et al. Clinicopathological characteristics and optimal management for esophagogastric junctional cancer；a single center retrospective cohort study[J]. J Exp Clin Cancer Res， 2013， 32：2.
20.	Kleinberg L. Therapy for locally advanced adenocarcinoma of the gastroesophageal junction：optimizing outcome[J]. Semin Radiat Oncol， 2013， 23(1)：38-50.
21.	Yang K， Chen HN， Chen XZ， et al. Transthoracic resection versus non-transthoracic resection for gastroesophageal junction cancer：a meta-analysis[J]. PLoS One， 2012， 7(6)：e37698.
22.	Matsumoto S， Takayama T， Wakatsuki K， et al. Surgical outcomes for cancer at the gastroesophageal junction[J]. Am Surg， 2012， 78(11)：1285-1291.
23.	Fox MP， van Berkel V. Management of gastroesophageal junction tumors[J]. Surg Clin North Am， 2012， 92(5)：1199-1212.
24.	Xia BT， Rosato EL， Chojnacki KA， et al. Major perioperative morbidity does not affect long-term survival in patients undergoing esophagectomy for cancer of the esophagus or gastroesophageal junction[J]. World J Surg， 2013， 37(2)：408-415.
25.	侯沙尔，程雪涛，王韧，等. 带血管系膜空肠袋间置代胃术的临床应用[J]. 武警医学， 2003， 14(7)：411-412.
26.	陈群清，陈燕春，闫玉生，等. 带血管蒂空肠在重建消化道中的应用[J]. 第一军医大学学报， 2004， 24(2)：238-239.
27.	， 98(5)：568-574.

1. Chen XZ， Jiang K， Hu JK， et al. Cost-effectiveness analysis of chemotherapy for advanced gastric cancer in China[J]. World J Gastroenterol， 2008， 14(17)：2715-2722.
2. Yang L， Parkin DM， Ferlay J， et al. Estimates of cancer incidence in China for 2000 and projections for 2005[J]. Cancer Epidemiol Biomarkers Prev， 2005， 14(1)：243-250.
3. Yang L. Incidence and mortality of gastric cancer in China[J]. World J Gastroenterol， 2006， 12(1)：17-20.
4. Wen L， Chen XZ， Wu B， et al. Total vs. proximal gastrectomy for proximal gastric cancer：a systematic review and meta-analysis[J]. Hepatogastroenterology， 2012， 59(114)：633-640.
5. Huang Q. Carcinoma of the gastroesophageal junction in Chinese patients[J]. World J Gastroenterol， 2012， 18(48)：7134-7140.
6. Huang Q， Fan X， Agoston AT， et al. Comparison of gastro-oesophageal junction carcinomas in Chinese versus American patients[J]. Histopathology， 2011， 59(2)：188-197.
7. Wang K， Yang CQ， Duan LP， et al. Changing pattern of adeno-carcinoma of the esophagogastric junction in recent 10 years：experience at a large tertiary medical center in China[J]. Tumori，.
8. 胡建昆，陈心足. 进展期胃癌治疗方式合理选择及评价[J]. 中国实用外科杂志， 2011， 31(8)：720-722.
9. 胡建昆，陈心足. 食管胃结合部腺癌围手术期放化疗合理应用及评价[J]. 中国实用外科杂志， 2012， 32(4)：303-306.
10. 胡建昆，陈心足. 胃癌多学科协作诊疗模式现状[J]. 中国普外基础与临床杂志， 2012， 19(1)：1-3.
11. Liakakos T， Katsios C， Roukos DH. Gastroesophageal junction carcinoma multimodal treatment：standards， debate and new therapeutic options[J]. Expert Rev Gastroenterol Hepatol， 2011， 5(1)：1-4.
12. Stein HJ， Feith M， Siewert JR. Individualized surgical strategies for cancer of the esophagogastric junction[J]. Ann Chir Gynaecol， 2000， 89(3)：191-198.
13. Siewert JR， Stein HJ， Sendler A， et al. Surgical resection for cancer of the cardia[J]. Semin Surg Oncol， 1999， 17(2)：125-131.
14. Stein HJ， Feith M， Siewert JR. Cancer of the esophagogastric junction[J]. Surg Oncol， 2000， 9(1)：35-41.
15. 代斌，潘琳，杨晨，等. 食管胃结合部腺癌病人行近端与全胃切除术后生活质量比较[J]. 中国实用外科杂志， 2011， 31(2)：147-149.
16. Sasako M， Sano T， Yamamoto S， et al. Left thoracoabdominal approach versus abdominal-transhiatal approach for gastric cancer of the cardia or subcardia：a randomised controlled trial[J]. Lancet Oncol， 2006， 7(8)：644-651.
17. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3)[J]. Gastric Cancer， 2011， 14(2)：113-123.
18. 胡建昆，陈心足. 胃癌手术消化道重建方式的选择及评价[J]. 中华消化外科杂志， 2013， 12(1)：25-29.
19. Ito H， Inoue H， Odaka N， et al. Clinicopathological characteristics and optimal management for esophagogastric junctional cancer；a single center retrospective cohort study[J]. J Exp Clin Cancer Res， 2013， 32：2.
20. Kleinberg L. Therapy for locally advanced adenocarcinoma of the gastroesophageal junction：optimizing outcome[J]. Semin Radiat Oncol， 2013， 23(1)：38-50.
21. Yang K， Chen HN， Chen XZ， et al. Transthoracic resection versus non-transthoracic resection for gastroesophageal junction cancer：a meta-analysis[J]. PLoS One， 2012， 7(6)：e37698.
22. Matsumoto S， Takayama T， Wakatsuki K， et al. Surgical outcomes for cancer at the gastroesophageal junction[J]. Am Surg， 2012， 78(11)：1285-1291.
23. Fox MP， van Berkel V. Management of gastroesophageal junction tumors[J]. Surg Clin North Am， 2012， 92(5)：1199-1212.
24. Xia BT， Rosato EL， Chojnacki KA， et al. Major perioperative morbidity does not affect long-term survival in patients undergoing esophagectomy for cancer of the esophagus or gastroesophageal junction[J]. World J Surg， 2013， 37(2)：408-415.
25. 侯沙尔，程雪涛，王韧，等. 带血管系膜空肠袋间置代胃术的临床应用[J]. 武警医学， 2003， 14(7)：411-412.
26. 陈群清，陈燕春，闫玉生，等. 带血管蒂空肠在重建消化道中的应用[J]. 第一军医大学学报， 2004， 24(2)：238-239.
27. ， 98(5)：568-574.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Arch-Preserved Jejunum in Total Gastrectomy with Roux-en-Y Esophagojejunostomy

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