Objective To study the necessity and feasibility of No.12b lymph node dissection in D2 lymphadenectomy for advanced distal gastric cancer, and the relation between No.12b lymph node metastasis and clinicopathologic factors. Methods Clinical data of sixty cases of advanced distal gastric cancer receiving D2 or D2+ radical correction were collected retrospectively, both of which were all plus No.12b lymph node dissections. The relationships between No.12b lymph node metastasis and clinicopathologic factors were analyzed. Results No death attributed to operation or severe operative complications were found. There were 12 cases (20.00%) with No.12b lymph node metastasis. The rates of No.12b lymph node metastasis in Borrmann Ⅲ-Ⅳ types, N2-3 of lymph node metastasis and T3-4 of tumor infiltration were 31.25% (10/32), 30.30% (10/33) and 29.73% (11/37), which were significantly higher than those in Borrmann Ⅰ-Ⅱ types 〔7.14% （2/28）〕, N0-1 〔7.41% （2/27）〕 and T1-2 〔4.35% （1/23）〕 respectively (Plt;0.05). There was no relationship between tumor size and No.12b lymph node metastasis. Conclusions No.12b lymph node dissection is safe and feasible for advanced distal gastric cancer. Further perspective studies on No.12b lymph node dissection influence on prognosis in more cases are required.
ObjectiveTo systemically evaluate safety and effectiveness of laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrostomy(CODG) with D2 lymph node dissection for Chinese patients with distal gastric cancer. MethodsLiterature were searched in PubMed database, the Cochrane Library, China science citation database (CSCD), Wanfang database, China science and technology journal database (CSTJ), China biomedical literature database (CBM), and China academic journal network publishing database (CAJD) to identify clinical random controlled trials, comparing safety and effectiveness of LADG and CODG with D2 lymph node dissection for Chinese patients with distal gastric cancer. The retrieval time was from the inception to Jun. 2013. Meta-analysis was performed by Review Manager 5.2 software. ResultsA total of 7 clinical random controlled trials including 548 patients were analyzed. Compared with CODG group, LADG group had less blood loss (MD=-94.02, 95% CI:-140.96--47.07), shorter postoperative hospital stay(MD=-3.66, 95% CI:-5.76--1.57), earlier postoperative ambulation time(MD=-1.95, 95% CI:-2.74--1.17), earlier postoperative exhaust time (MD=-1.67, 95% CI:-2.05--1.30), lower incidence of complications(OR=0.26, 95% CI:0.14-0.51), P<0.050. But the operation time was longer in LADG group (MD=35.01, 95% CI:10.41-59.61, P=0.005). There was no significant difference between LADG group and CODG group on number of lymph node which were dissected during the operation (MD=-0.24, 95% CI:-0.99-0.51, P=0.530). ConclusionThe short-term outcome and safety of LADG for Chinese patients with distal gastric cancer is superior to CODG, but LADG prolongs the operation time and its long-term outcome should be proved by further outcomes of clinical controlled trials.
ObjectiveTo investigate the clinical efficacy and short-term complications of total laparoscopic distal gastrectomy, which adopting Billroth Ⅱ combining with Braun anastomosis. MethodsClinical data of 186 cases of distal gastric cancer who underwent total laparoscopic distal gastrectomy in our hospital from June 2012 to June 2014, including 86 cases who adopted Billroth Ⅱ combining with Braun anastomosis, and 100 cases who adopted Billroth Ⅱ anastomosis. The clinical efficacy was compared between these two groups. ResultsThere was no significant difference in the opera-tion time, digestive tract reconstruction time, intraoperative blood loss, postoperative exhaust time, and hospital stay (P>0.05). However, compared with Billroth Ⅱ anastomosis group, the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsurgical gastroparesis syndrome were lower in Billroth Ⅱ combining with Braun anastomosis group (P<0.05). ConclusionThe application of Billroth Ⅱ combining with Braun anastomosis in total laparoscopic distal gastrectomy could reduce the incidence rates of alkaline reflux gastritis, duodenal fistula, anastomositis, and postsur-gical gastroparesis syndrome, and it is an ideal operation method to improve the quality of life for gastric cancer patients.
ObjectiveTo investigate safety and feasibility of early oral feeding after laparoscopic radical distal gastrectomy. MethodsOne hundred and fifty patients with gastric cancer admitted to hospital from May 2015 to Feb-ruary 2016 were divided into early oral feeding (EOF) group and traditional feeding (TF) group by a randomized contro-lled way. The relevant postoperative indicators, including postoperative complications (wound infection, inflammatory intestinal obstruction, anastomotic leakage, pulmonary infection, gastric retention), feeding tolerance (nausea, vomiting, and reinserting of gastric tube), nutritional status (serum albumin, prealbumin), immune function (IgA, IgG, IgM), recovery of gastrointestinal function (postoperative the first anal exhaust time and defecation time), hospitalization time, and hospitalization expenses, were observed and analyzed. Results① One hundred and thirty-nine patients were included in this study, there were 72 cases in the EOF group, 67 cases in the TF group. The gender, age, boby mass index, etc. had no statistic significances between these two groups (P>0.05). ② All the patients of the two groups were cured and discharged, no patients died during perioperative period. The postoperative the first anal exhaust time, defecation time, and hospitalization time of the EOF group were significantly less than those of the TF group (P<0.05). The operative time, intraoperative blood loss, and postoperative hospitalization expenses had no significant differences between these two groups (P>0.05).③ The levels of serum albumin, prealbumin, and IgA on day 7 after operation in the EOF group were significantly higher than those in the TF group (P<0.05). The levels of IgG and IgM on day 7 after operation had no significant differences between these two groups (P>0.05). ④The tolerance rates of oral feeding of the EOF group and TF group patients was 91.7% (66/72) and 94.0% (63/67) respectively, the difference was not statistically significant (χ2=0.044, P=0.833). While 2 patients needed to be inserted gastric tube again due to nausea and abdominal distention in the EOF group, the symptoms were cured with conservative treatment about 3 d.⑤ The postoperative complications of the EOF group were 10 cases, TF group were 10 cases, the difference was not statistically significant (χ2=0.173, P=0.677). And postoperative complications were cured and discharged after active conservative treatment. Postoperative follow-up of 102 (102/139) cases were completed, follow-up time was 1-6 months, no patients admitted to hospital again for postopera-tive complications. ConclusionEarly oral feeding after laparoscopic radical distal gastrectomy is safe and feasible, which don't only increase incidence of complications, but also improve nutritional status of patients, and promote recoveries of immune function and intestinal function, and shorten postoperative hospitalization time.
ObjectiveTo investigate the feasibility of totally laparoscopic distal gastrectomy (TLDG) based on delta-shaped gastroduodenostomy in the treatment of gastric cancer. MethodsNinety 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. Results① 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. ConclusionThe 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.
Objective To explore method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal gastric cancer (GC). Methods The clinical data of 30 patients with distal GC underwent the total laparoscopic radical gastrectomy from October 2017 to March 2018 in the Departmeng of Tumor Surgery, Lanzhou University Second Hospital were retrospectively analyzed, the total laparoscopic radical distal gastrectomy were performed in all the patients and the jejunum nutrition tube were implanted during the operation. Results Thirty patients with distal GC were successfully treated with the total laparoscopic radical gastrectomy and the jejunum nutrition tubes were implanted into under the total laparoscopy through the intraoperative guidance by the gastric tube, firstly fastening the nutrition tube to the gastric tube in vitro, and then separating them in vivo, finally the nutrition tube was smoothly implanted into the jejunum under the direct vision. The implantation time was 10 to 15 min with an average of 13.5 min. The jejunal nutrition tube retention time was 5 to 7 d with an average of 6 d. There were no complications such as the bleeding, anastomotic leakage, anastomotic obstruction, stenosis, intestinal leakage, intestinal obstruction, and other complications after the operation in the 30 patients. Conclusions Method of jejunum nutrition tube implantation in total laparoscopic radical gastrectomy for distal GC is easy to be performed. Intraoperative and postoperative complications are few. It provides a favorable guarantee for improving postoperative nutritional status of patient with distal GC.
ObjectiveTo investigate the relationship between metastatic lymph node ratio (MLNR) and prognosis of patients after radical resection of distal gastric cancer.MethodsWe retrospectively analyzed the clinicopathological data of 408 patients undergoing radical resection of distal gastric cancer (D2 or D2+ lymph node dissection) in Department of Gastrointestinal Surgery in the Affiliated Hospital of Southwest Medical University, from January 2010 to January 2014. Then we explored the influence of MLNR on the prognosis after radical resection of distal gastric cancer.ResultsWithout distinguishing pTNM staging, the overall survival situation of patient with MLNR≥0.15 and patient with MLNR<0.15 was statistically significant (χ2=3.775, P=0.046); when patients with staging of pTNM Ⅰ, there was no statistically significant MLNR could be calculated; when patients with staging of pTNM Ⅱ, the overall survival situation of patient with MLNR≥0.14 and patient with MLNR<0.14 was statistically significant (χ2=3.110, P=0.029); when patients with staging of pTNM Ⅲ, the overall survival situation of patient with MLNR≥0.10 and patient with MLNR<0.10 was statistically significant (χ2=1.631, P=0.004). Multivariate analysis showed that depth of invasion (pT stage) and MLNR were independent prognostic factors for prognosis of patients after radical resection of distal gastric cancer (P<0.05).ConclusionMLNR is a good prognostic indicator for patients with distal gastric cancer after radical resection.
ObjectiveTo analyze the risk factors affecting delayed gastric emptying (DGE) after laparoscopic distal gastrectomy for gastric cancer. MethodsThe gastric cancer patients who underwent laparoscopic distal gastrectomy in the Jiaozuo People’s Hospital from January 1, 2013 to December 31, 2022 were retrospectively collected. The occurrence of DGE was recorded. Meanwhile, the multivariate binary logistic regression analysis was performed to screen the risk factors affecting the DGE. ResultsA total of 350 gastric cancer patients underwent laparoscopic distal gastrectomy and met the inclusion and exclusion criteria of this study were included, 17 (4.9%) of whom developed DGE. The multivariate binary logistic regression analysis results showed that the preoperative gastric outflow tract obstruction (OR=8.582, P=0.009), intraoperative jejunal nutrition tube indwelling (OR=14.317, P=0.010), more peritoneal drainage tube placement (OR=5.455, P=0.006), and intraoperative blood loss ≥140 mL (OR=4.912, P=0.018) increased the risk of DGE. ConclusionAccording to the results of this study, when patients undergoing laparoscopic distal radical gastrectomy for gastric cancer accompanied by preoperative gastric outflow tract obstruction, intraoperative jejunal nutrition tube indwelling, more peritoneal drainage tube placement, and more intraoperative blood loss, it should be paid more attention to prevention DGE, and early detection and treatment, so as to improve the prognosis of patients.