Total Gastrectomy Research Articles

Comparison of laparoscopic and open total gastrectomy with D2 lymphadenectomy for gastric cancer: a propensity score matched study

Comparison of laparoscopic and open total gastrectomy with D2 lymphadenectomy for gastric cancer: a propensity score matched study

Reconstruction techniques after partial and total gastric resection

The domains of gastric surgery are nowadays oncological resections, often as part of multimodal treatment concepts. Depending on the extent of the gastric resection as total, proximal or distal (or subtotal) gastrectomy, different methods of reconstruction are available. These reconstruction procedures have not basically changed with the implementation of minimally invasive or robotic techniques but the spectrum of possible anastomotic techniques has been substantially expanded. Functional, in particular nutritional disorders with subsequent impairment of the postoperative health-related quality of life, are often observed after gastric resection. After surgical resection these disorders principally occur less frequently with partial preservation of agastric residue. After (total) gastrectomy, the placement of ajejunal pouch significantly reduces the incidence of postoperative dumping symptoms. Following proximal gastrectomy, double-tract reconstruction provides certain functional advantages as compared to the Roux‑en-Y.

Provision of additional oral nutritional supplements to postgastrectomy patients based on regular diet intake to meet their energy requirements reduces body weight loss.

Provision of additional oral nutritional supplements to postgastrectomy patients based on regular diet intake to meet their energy requirements reduces body weight loss.

Endoscopic ultrasound-guided antegrade biliary intervention for choledocholithiasis in total gastrectomy with Roux-en-Y anatomy

Endoscopic ultrasound-guided antegrade biliary intervention for choledocholithiasis in total gastrectomy with Roux-en-Y anatomy

Hiccups as the First Symptom of a Complication of Total Gastrectomy for Gastric Cancer with a Negative Objective Abdominal Examination: A Case Report and Review of the Literature

Total gastrectomy with D2 lymphadenectomy for gastric cancer is a complex surgical procedure with a moderate complication rate. Sometimes, some complications may have a misleading onset without a clear clinical presentation and blood test changes. In this case report, hiccups were the main symptom of subdiaphragmatic fluid collection after total gastrectomy.

Proximal gastrectomy as an alternative to total gastrectomy in patients with advanced proximal gastric cancer: propensity score matching analysis of the 2-center study in European population.

Proximal gastrectomy as an alternative to total gastrectomy in patients with advanced proximal gastric cancer: propensity score matching analysis of the 2-center study in European population.

Application status of vagus nerve preservation and double-flap technique in laparoscopic proximal gastrectomy

Function-preserving gastrectomy has been gradually implemented in China. Under the premise of oncologic safety,such surgery is crucial for improving patients' postoperative quality of life. Although proximal gastrectomy is a classic surgical method for the adenocarcinoma of esophagogastric junction,no consensus exists on the vagus nerve preservation and digestive tract reconstruction. How to preserve the vagus nerve and pyloric function, and avoid postoperative gastroesophageal reflux after proximal gastrectomy has consistently been the focus of clinical research on proximal gastrectomy. This study introduces the application of laparoscopic proximal gastrectomy with nerve vagus preservation combined with double-flap anastomosis in proximal early gastric cancer. The hepatic branches and the celiac branches are both preserved during the surgical procedure,and the manufacture of double-flap is completed through auxiliary incisions. The anastomosis of the esophagus and the remnant stomach is performed under laparoscopy. It conforms to the physiological structure and preserved the functions of the stomach,which avoided weight loss and nutritional absorption disorder after total gastrectomy. Additionally, it reduces the incidence of reflux esophagitis following traditional esophagogastrostomy, thereby improving patients' postoperative quality of life.

Outcomes of minimally invasive vs open total gastrectomy for gastric adenocarcinoma.

Outcomes of minimally invasive vs open total gastrectomy for gastric adenocarcinoma.

Nutritional and Biochemical Outcomes After Total Versus Subtotal Gastrectomy: Insights into Early Postoperative Prognosis

Gastric cancer remains a significant global health burden, with curative treatment relying on surgical resection, typically total or subtotal gastrectomy. However, the procedure frequently triggers acute metabolic and nutritional disturbances that may impact recovery. Objective: This prospective study aimed to investigate whether the type of gastrectomy (total vs. subtotal) influences early postoperative biochemical and hematological alterations, with particular attention to nutritional impact. Methods: A cohort of 295 patients (123 female, 172 male) who underwent gastrectomy for gastric cancer at the Institute of Oncology Iași (2023–2024) was evaluated. Laboratory parameters, including hemoglobin, hematocrit, lymphocyte and platelet counts, serum albumin, total protein, sodium, potassium, creatinine, and urea, were analyzed preoperatively and on postoperative day 14 using standard clinical methods. Results: Anemia was observed in over 90% of patients, irrespective of sex or procedure type. Electrolyte imbalances (notably hyponatremia and hypokalemia) and indicators of nutritional deficit (hypoalbuminemia, low creatinine) were highly prevalent, with a greater frequency among female patients. Total gastrectomy was associated with more severe biochemical and nutritional alterations compared to subtotal procedures. Conclusions: Total gastrectomy significantly exacerbates early postoperative metabolic and nutritional derangements. These findings reinforce the need for proactive, personalized postoperative nutritional and electrolyte management strategies to support recovery and reduce complication risks.

Application of modified Roux-en-Y digestive tract reconstruction in total gastrectomy for patients with gastric cancer.

At present, the concept of surgical treatment of gastric cancer (GC) has changed from "radical treatment" to "care for patients" to a certain extent. The reconstruction method is the most likely to affect the postoperative life of the patient. Currently, the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC. However, more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure, with more reconstruction steps and longer reconstruction time, and the incidence of postoperative complications such as adhesive intestinal obstruction, internal abdominal hernia and volvulus is high. Moreover, the incidence of Roux stasis syndrome is 10%-30% after traditional Roux-en-Y reconstruction. Thus, we modified the traditional Roux-en-Y alimentary tract reconstruction, and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC. To evaluate the clinical advantages, feasibility, and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method. Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy (total gastrectomy) for GC were divided into two groups: fifty-four in the conventional Roux-en-Y reconstruction group (Orr group) and forty-three in the modified Roux-en-Y reconstruction group (the modified group). Perioperative and short-term outcomes were analyzed, including complications, postoperative weight loss, hemoglobin levels, and nutritional status. The Orr group and the modified group showed no statistically significant differences in baseline characteristics. Compared with the Orr group, the modified group had shorter digestive tract reconstruction and operation times, less intraoperative bleeding, and shorter postoperative hospital stays compared to the Orr group. Although both groups had similar amounts of intraoperative blood loss, postoperative recovery times, and hospital expenses, the Orr group experienced longer operation times and digestive tract reconstruction times. Furthermore, the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications, with a reduced incidence of reflux esophagitis and improved nutritional status. The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety, simplicity, and a reduction in bile reflux. This method shortens operation times and minimizes postoperative complications, aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival. This method warrants further clinical application and promotion.

Effect of double-tract reconstruction and laparoscopic proximal gastrectomy on immune function and stress.

Although surgery remains the primary treatment for proximal gastric cancer (PGC), ongoing refinements in surgical strategies are essential to improving clinical outcomes. To investigate the effect of double-tract reconstruction (DTR) on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy (LPG). In total, 78 patients with PGC admitted between August 2020 and August 2024 were enrolled. The research group consisted of 39 patients who underwent DTR + LPG, whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy. Perioperative indices (intraoperative blood loss, digestive tract anastomosis time, and time to first postoperative flatus), postoperative complications (intestinal obstruction, anastomotic ulcer, diarrhea, dumping syndrome, and gastroesophageal reflux), nutritional parameters (serum albumin, hemoglobin, and body mass index), immune function [immunoglobulin (Ig) G, IgA, and IgM), and stress response indicators (C-reactive protein, interleukin-6, and tumor necrosis factor-α) were collected and analyzed for both groups. The intraoperative blood loss was lower (P < 0.05), and the time to first postoperative flatus time was shorter (P < 0.001) in the research group than in the control group. The two groups had comparable digestive tract anastomosis time (P > 0.05). The overall complication rate was significantly lower in the research group than in the control group (P = 0.042). Compared with the control group, the research group exhibited notably higher albumin, hemoglobin, and body mass index levels at 2 and 3 months postoperatively, as well as considerably high immunoglobulin (Ig) G, IgA, and IgM levels on postoperative day 1 (P < 0.05). The postoperative levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were also lower in the research group than in the control group (P < 0.001). The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses, showing more advantages over laparoscopic total gastrectomy.

Risk factors as criteria for drain use in gastrectomy: A prospective study

Total gastrectomy with D2 lymph node dissection remains the standard treatment option for resectable esophagogastric junctional and gastric cancer; however, high rates of morbidity lead to challenges in perioperative care. The Enhanced Recovery after Surgery (ERAS) guidelines advise against the use of routine drains; yet, conflicting evidence leads to inconsistent use in clinical practice. The Drains After Gastrectomy (DRaG) trial was a prospective, non-randomized study conducted from February 2020 to March 2023 at the Hippocration General Hospital, University of Athens. Patients undergoing open D2 total gastrectomy were treated with perianastomotic drainage based on evidence-based criteria, offering a tailored approach to treatment. Immediate and short-term post-operative outcomes, including complications and key milestones in recovery, were assessed.In total, 60 patients were included in the prospective study, with 40 receiving a drain based on evidence-supported, case-based criteria. The non-drain group exhibited lower pain scores, earlier rates of mobilization, lower levels of post-operative nausea and vomiting, and shorter hospital stays. By contrast, patients presenting with complications experienced a delayed post-operative recovery, which may have been associated with the use of the drain. Although adverse effects are common, the application of specific criteria may aid clinical decision making. In conclusion, the present study aimed to provide a criteria-based approach for individualising drain placement in gastrectomy. Notably, the findings of the present study are comparable with those of existing studies; thus, the suggested criteria offer a structured and reliable approach to the use of drain placement following gastrectomy in surgical practice.

Robotic versus laparoscopic total gastrectomy for gastric cancer: a systematic review and meta-analysis of perioperative and oncologic outcomes.

While robotic total gastrectomy (RTG) has gained traction in minimally invasive gastric cancer surgery, high-level evidence comparing its efficacy with laparoscopic total gastrectomy (LTG) remains limited. This systematic review and meta-analysis aimed to comprehensively evaluate the comparative efficacy and safety of RTG versus LTG in gastric cancer patients, thereby informing evidence-based surgical decision-making. We systematically searched PubMed, Embase, Cochrane Library and Web of science databases from inception until November 2024 for comparative studies of RTG and LTG. Perioperative outcomes (intraoperative blood loss, severe complications [Clavien-Dindo grade ≥3], abdominal infection rates, postoperative hospitalization) and oncologic parameters (retrieved lymph nodes, 3-year overall survival [OS], disease-free survival [DFS]) were analyzed. Risk ratios (RR) and weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated. Protocol registered with PROSPERO. The results revealed that RTG significantly reduced severe complications (CD ≥3), abdominal infection, intraoperative blood loss, and postoperative hospital stay compared to LTG. Additionally, RTG led to an increased number of retrieved lymph nodes. However, no significant differences were observed in three-year OS and DFS between RTG and LTG, consistent with findings from other types of gastrectomy. The subgroup analysis demonstrated that the use of linear staplers was more effective in reducing severe complications and postoperative hospital stay. RTG confers superior perioperative safety profiles compared to LTG while maintaining equivalent oncologic outcomes. The technical advantages of robotic platforms-particularly enhanced instrument maneuverability in narrow spaces-may explain reduced intraoperative trauma and complication risks. These findings support RTG as a viable option for centers with robotic expertise, though cost-effectiveness analyses remain warranted.

Impact of Ghrelin‐Depleting Gastrectomy on Long‐Term Endocrine and Metabolic Health With a Focus on Skeletal Muscle and Bone Mineral Content

ABSTRACTBackgroundAdvances in diagnostic and surgical techniques have improved survival rates for gastric cancer patients. However, gastrectomy involving ghrelin‐secreting regions of the upper gastric greater curvature can lead to long‐term endocrine and metabolic disturbances, including reductions in serum ghrelin and insulin‐like growth factor‐1 (IGF‐1), potentially contributing to skeletal muscle and bone mineral loss.MethodsThis prospective observational study included 35 gastric cancer patients who underwent gastrectomy between 2016 and 2018, with follow‐up for 3–5 years. Patients were categorized into ghrelin‐depleted (total or proximal gastrectomy) and ghrelin‐preserved (distal gastrectomy) groups. Serum desacyl‐ghrelin, IGF‐1, and insulin‐like growth factor‐binding protein‐3 (IGFBP‐3) levels were measured, and skeletal muscle mass and bone mineral content were assessed.ResultsThe ghrelin‐depleted group exhibited significantly lower serum desacyl‐ghrelin (56.9 ± 27.9 vs. 111.2 ± 54.8 fmol/mL, p = 0.0006), skeletal muscle mass (87.7% ± 2.1% vs. 95.1% ± 2.4%, p = 0.0229), and bone mineral content (90.9% ± 13.0% vs. 99.5% ± 6.3%, p = 0.0249). Additionally, IGF‐1 levels showed a significant positive correlation with skeletal muscle mass (r = 0.53, p = 0.020). While the correlation between IGF‐1 and bone mineral content did not reach statistical significance, a positive trend was observed (r = 0.44, p = 0.062).ConclusionGastrectomy involving resection of ghrelin‐rich regions leads to long‐term reductions in serum desacyl‐ghrelin levels, adversely affecting skeletal muscle mass and bone mineral content. These findings highlight the importance of considering the endocrine consequences when selecting surgical procedures.

Overlap Versus π-Shaped Esophagojejunostomy After Laparoscopic Total Gastrectomy for Gastric Cancer: A Comparative Study.

An increasing number of medical professionals are choosing to use totally laparoscopic total gastrectomy (TLTG) as a treatment option for gastric cancer. However, the optimal reconstruction method is still under debate. The objective of this study is to evaluate the immediate results of 2 intracorporeal esophagojejunostomy techniques: overlap (isoperistaltic side-to-side) (O) and pi-shaped (π) (anisoperistaltic side-to-side) anastomosis. Hospital records of 110 patients who underwent esophagojejunostomy (group O, n=65 or group π, n=45) after TLTG from January 2016 to December 2019 were retrospectively reviewed. The demographic and clinicopathologic characteristics, along with the surgical and pathologic results, were recorded, compared, and evaluated for immediate impacts. The demographic characteristics of the 2 groups exhibited no significant disparities. Moreover, there were no statistically notable differences in tumor size, lymph node count, or TNM stage between the 2 groups. All surgeries were successfully completed without any complications or need for conversion to laparotomy, and there were no occurrences of postoperative mortality. In addition, there were no statistically significant variances between the 2 groups in terms of total operation time, estimated blood loss, time to first flatus, or length of postoperative hospital stay. Time for esophagojejunostomy, however, was statistically significantly shorter in group π than in group O (27.4±5.2 vs. 36.7±5.0min) (P<0.001). No statistically significant difference was found between the 2 groups with regard to postoperative complications: 5 grade I, 6 grade II, and 1 grade IIIa in group O (n=12) versus 5 grade I, 3 grade II, 2 grade IIIa, and 1 grade IIIb in group π (n=11). At 6-month endoscopy and oral water-soluble contrast medium follow-up, no anastomotic complication was noted. The π anastomosis is feasible, safe, with the need for fewer cartridges and is eventually a time-saving procedure for esophagojejunostomy with no hand-sewing involved. In this study, both methods have shown favorable short-term results in the treatment of gastric cancer.

Giant Gastric GIST Manifesting as Profound Iron Deficiency Anemia: A Case Report of a Diagnostic Pitfall

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, yet they remain rare, particularly in patients under 40. Their clinical presentation is highly variable, often posing a diagnostic challenge. Severe anemia as the initial manifestation is common, but diagnostic confusion with benign lesions on initial biopsy is a significant clinical pitfall. Case presentation: A 39-year-old male presented with a three-month history of epigastric pain, early satiety, significant weight loss, and profound fatigue. His initial hemoglobin was a life-threatening 3.8 g/dL, consistent with profound iron deficiency anemia. Esophagogastroduodenoscopy (EGD) revealed a large, partially obstructing mass in the gastric corpus. However, initial endoscopic biopsies were paradoxically reported as a benign hyperplastic polyp. In contrast, contrast-enhanced computed tomography (CT) of the abdomen characterized a massive, 9.9 x 7.3 x 13.5 cm heterogeneously enhancing mass suggestive of malignancy. Given the stark discrepancy between imaging and histology, a decision was made for surgical intervention. The patient underwent a total gastrectomy. Final histopathological analysis of the resected specimen, supported by immunohistochemistry, confirmed a high-risk gastrointestinal stromal tumor with a high mitotic rate. Conclusion: This case underscores the critical importance of maintaining a high index of suspicion for GIST in patients with unexplained iron deficiency anemia, even in younger age groups. It highlights the potential for sampling error with endoscopic biopsies of large submucosal tumors, which can lead to dangerously misleading diagnoses. Clinicians must integrate clinical, radiological, and endoscopic findings to guide management, especially when histopathological results are incongruent with the overall clinical picture.

Comment on "Risk Factors for Esophagojejunal Anastomotic Leakage after Total Gastrectomy".

Comment on "Risk Factors for Esophagojejunal Anastomotic Leakage after Total Gastrectomy".

Reproductive decision-making and pregnancy in germline CDH1 variant carriers.

Diagnosis of a hereditary cancer syndrome may impact family planning, particularly in reproductive age individuals. Factors influencing reproductive decision-making are understudied in individuals with germline CDH1 pathogenic or likely pathogenic (P/LP) variants. We characterised reproductive decision-making and perinatal outcomes in 121 individuals aged 18-49 with hereditary diffuse gastric and lobular breast cancer syndrome due to a germline CDH1 P/LP variant. Half of individuals (50%, 60/121) reported their CDH1 diagnosis impacted family planning. Psychosocial and economic barriers to reproduction were encountered by 47% (56/119) of patients. Additionally, 12% (15/121) of individuals delayed pregnancy to prioritise personal cancer risk management with either endoscopic surveillance, prophylactic total gastrectomy (PTG) or mastectomy. Women were more likely to experience guilt about passing their CDH1 variant to offspring compared with men. Perinatal and fetal outcomes were investigated in six women who gave birth at a median time of 24 months (IQR 20-44) after PTG. Maternal micronutrient deficiencies were not uncommon in pregnant women after PTG despite compliance with a bariatric, prenatal multivitamin. Majority of women who became pregnant after PTG reported worsening post-gastrectomy syndromes. Most infants (90%, 9/10) born after PTG were full-term and no fetal complications were reported. Reproductive decision-making is complex in individuals with germline CDH1 variants, who often encounter psychosocial and physical challenges during family planning and pregnancy. However, successful pregnancy is possible after PTG with the guidance of a multidisciplinary team including maternal fetal medicine specialists and a registered dietitian. NCT03030404.

Clinical utility of self-expandable metal stents in the treatment of anastomotic obstruction secondary to recurrent gastric cancer.

The purpose of this study was to assess the efficacy and safety of self-expandable metal stents (SEMS) in treating anastomotic obstruction associated with recurrent gastric cancer. Ten patients with anastomotic obstruction in recurrent gastric cancer were treated by SEMS implantation under fluoroscopic guidance. All patients presented with refractory nausea, vomiting and complete inability to tolerate oral intake before stent placement, requiring total parenteral nutrition (TPN). Clinical data were retrospectively analyzed the technical and clinical success rates, stent patency and complication rates. SEMS was successfully implanted in all patients, and clinical success rate was 100%. The operations were subtotal gastrectomy with Billroth-II reconstruction (n = 3), radical distal gastrectomy (n = 3), total gastrectomy with esophagojejunostomy (n = 3), and palliative gastrojejunostomy (n = 1). Three patients developed stent occlusion due to intrastent tumor ingrowth secondary to disease progression after initial anastomotic stent placement, and underwent secondary stent implantation with successful maintenance of patency postoperatively. One patient developed stent obstruction due to food impaction on postoperative day 10, which was managed endoscopically with successful restoration and maintenance of luminal patency. The mean stent patency was 78d (range, 8-225 d). No serious complications, such as anastomotic leakage, stent migration and bleeding were observed in these patients. Fluoroscopically-guided SEMS placement represents a technically safe and clinically effective intervention for managing anastomotic obstructions in recurrent gastric cancer. SEMS placement offers rapid symptom relief, shorter hospital stays, and improved quality of life compared to surgical alternatives in this patient population. Thus, based on its technical feasibility and clinical outcomes, this method warrants primary consideration in palliative treatment algorithms.

Robotic left gastric vein reimplantation to prevent gastric venous congestion in total pancreatectomy.

Gastric venous congestion (GVC) is a significant but often underrecognized complication of total pancreatectomy (TP). Although left gastric vein (LGV) reimplantation can prevent GVC, its feasibility in robotic surgery has not previously been described. We report our initial experience with LGV reimplantation in three TP cases. In one case, conversion to open surgery was required prior to LGV reimplantation. In this patient, despite patency of the reconstructed LGV, GVC developed and necessitated total gastrectomy due to rapidly worsening lactate acidosis and hemodynamic instability. In the remaining two cases, robotic LGV reimplantation was completed successfully, with immediate gastric decompression and uneventful postoperative recovery. These findings highlight the potential clinical relevance of GVC and demonstrate that robotic assistance enables LGV reimplantation, even in anatomically challenging settings. This experience broadens the scope of vascular reconstruction in robotic pancreatic surgery and supports the expanding role of minimally invasive approaches in managing complex surgical scenarios.