Application value of π-shaped Roux-en-Y esophagojejunostomy in totally laparoscopic total gastrectomy

Abstract

Objective To investigate the application value of π-shaped esophagojejunostomy in totally laparoscopic total gastrectomy. Methods The retrospective and descriptive study was conducted. The clinicopathological data of 3 patients who underwent totally laparoscopic total gastrectomy in the Beijing Friendship Hospital of Capital Medical University between October 2016 and March 2017 were collected. Patients received π-shaped Roux-en-Y esophagojejunostomy. Patients who were diagnosed with Ⅱ and above stages by pathological examination underwent postoperative adjuvant chemotherapy with oxaliplatin + tegafur gimeracil oteracil. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up and survival situations. The follow-up using outpatient examination and telephone interview was performed to detect postoperative adjuvant therapy and survival up to March 2018. Results (1) Surgical and postoperative recovery situations: 3 patients underwent successfully totally laparoscopic total gastrectomy, and π-shaped Roux-en-Y esophagojejunostomy was also performed. Case 1 had injury of spleen vessel when No 11p lymph nodes were dissected and then received successful hemostasis, and case 2 and 3 didn′t have complication. Operation time, digestive tract reconstruction time, volume of intraoperative blood loss, time to anal exsufflation and postoperative drainage-tube removal time of case 1, 2 and 3 were respectively 376 minutes, 290 minutes, 284 minutes and 26 minutes, 30 minutes, 24 minutes and 500 mL, 100 mL, 200 mL and 2 days, 3 days, 3 days and 4 days, 4 days, 5 days. Case 3 with left pleural effusion was cured by puncture and drainage treating, and case 1 and 2 didn′t have complication. Three patients were not complicated with anastomotic stoma-related complicaions. Results of postoperative pathological examination: number of lymph node dissected and TNM staging of case 1, 2 and 3 were respectively 20, 17, 20 and T1aN0M0 staging, T3N3M0 staging, T1bN0M0 staging. Duration of hospital stay in case 1, 2 and 3 was respectively 7 days, 8 days and 11 days. (2) Follow-up and survival situations: 3 patients were followed up, and follow-up time of case 1, 2 and 3 was respectively 18 months, 16 months, 12 months. During the follow-up, case 2 received postoperative adjuvant therapy, and then underwent palliative treatment of Paclitaxel and Xeloda after the case was rechecked out multiple liver metastases at postoperative month 12. Case 1 and 3 had disease-free survival. Conclusion The π-Shaped esophagojejunostomy is safe and feasible for totally laparoscopic total gastrectomy, and it can be used as an alternative to digestive tract reconstruction. Key words: Gastric neoplasms; Total gastrectomy; Digestive tract reconstruction; Esophagojejunostomy; Laparoscopy