Abstract
BackgroundThe present study introduced a modified delta-shaped gastroduodenostomy (DSG) technique and assessed the safety, feasibility and clinical results of this procedure in patients undergoing totally laparoscopic distal gastrectomy (TLDG) for gastric cancer (GC).Materials and MethodsA total of 102 patients with distal GC undergoing TLDG with modified DSG between January 2013 and December 2013 were enrolled. A retrospective study was performed using a prospectively maintained comprehensive database to evaluate the results of the procedure. Univariate and multivariate analyses were performed to estimate the predictive factors for postoperative morbidity.ResultsThe mean operation time was 150.6±30.2 min, the mean anastomosis time was 12.2±4.2 min, the mean blood loss was 48.2±33.2 ml, and the mean times to first flatus, fluid diet, soft diet and postoperative hospital stay were 3.8±1.3 days, 5.0±1.0 days, 7.4±2.1 days and 12.0±6.5 days, respectively. Two patients with minor anastomotic leakage after surgery were managed conservatively; no patient experienced any complications around the anastomosis, such as anastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that age, gastric cancer with hemorrhage and cardiovascular disease combined were significant factors that affected postoperative morbidity (P<0.05). Multivariate analysis found that gastric cancer with hemorrhage was the independent risk factor for the postoperative morbidity (P = 0.042). At a median follow-up of 7 months, no patients had died or experienced recurrent or metastatic disease.ConclusionsThe modified DSG was technically safe and feasible, with acceptable surgical outcomes, in patients undergoing TLDG for GC, and this procedure may be promising in these patients.
Highlights
It has been more than 20 years since the first laparoscopic surgery for gastric cancer (GC). [1] reconstruction of the digestive tract is important during the procedure, it is technically difficult and requires a highly skilled surgeon; the Billroth-I (B-I) anastomosis after totally laparoscopic distal gastrectomy (TLDG) is considered especially complex
Univariate analysis showed that age, gastric cancer with hemorrhage and cardiovascular disease combined were significant factors that affected postoperative morbidity (P,0.05)
The modified delta-shaped gastroduodenostomy (DSG) was technically safe and feasible, with acceptable surgical outcomes, in patients undergoing TLDG for GC, and this procedure may be promising in these patients
Summary
It has been more than 20 years since the first laparoscopic surgery for gastric cancer (GC). [1] reconstruction of the digestive tract is important during the procedure, it is technically difficult and requires a highly skilled surgeon; the Billroth-I (B-I) anastomosis after totally laparoscopic distal gastrectomy (TLDG) is considered especially complex. In order to simplify the operation procedures to obtain a simpler process and reduce the potential risk as far as possible to increase the safety of operation, the modified DSG was proposed with the hope that the method can be accepted and generalized by more surgeons. We introduce this modified DSG and evaluate its safety, feasibility and clinical results in patients undergoing TLDG for GC. The present study introduced a modified delta-shaped gastroduodenostomy (DSG) technique and assessed the safety, feasibility and clinical results of this procedure in patients undergoing totally laparoscopic distal gastrectomy (TLDG) for gastric cancer (GC)
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