Short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radical total gastrectomy

Abstract

Objective To investigate the short-term efficacy of esophagojejunostomy by delta-shaped anastomosis in totally laparoscopic radical total gastrectomy.Methods The clinical data of 5 patients with esophagogastric cancer and 2 with non-cardia gastric cancer who were admitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine from July to October 2013 were retrospectively analyzed.All the 7 patients received totally laparoscopic radical total gastrectomy and esophagojejunostomy by delta-shaped anastomosis after preoperative evaluation.All the patients were followed by out-patient examination and phone call till November 2013.Results The operation was successfully carried out on all the 7 patients.The operation time was (234 ±23) minutes,and the time for delta-shaped anastomosis was (34 ± 7) minutes.The volume of intraoperative blood loss was (153 ±32)mL,and the number of lymph node harvest was 36 ±4.Seven staplers with 60 mm in length were applied.No anastomotic stricture was detected in the endoscopy for the first 3 patients after esophagojejunostomy.All the 7 patients recovered well,and the gastric tube was removed at postoperative day 1.The time for first flatus,liquid and semi-liquid food intake were (2.4 ± 0.5) days,(4.0 ± 0.6) days,(5.3 ± 0.5) days,respectively.No anastomotic bleeding,leakage,stricture or peritoneal infection was detected.No patients died perioperatively.Upper gastrointestinal imaging for the first 3 patients at postoperative day 5 showed unobstructed digestive tract.The numbers of patients in stage Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B were 3,2,1,1.The duration of postoperative hospital stay was (9.7 ± 1.4) days.The median time of follow-up was 3 months.The general condition of the patients was good,with no body weight loss,choking or substernal burning.Conclusions Esophagojejunostomy by deltashaped anastomosis in totally laparoscopic radical total gastrectomy is safe and feasible.The size of anastomosis is not restricted to the diameters of esophagus and jejunum,and the short-term efficacy is satisfactory. Key words: Adenocarcinoma of the esophagogastric junction; Gastric neoplasms; Laparoscopy; Esophagojejunostomy