Abstract: Objective:To explore the safety and feasibility of the πshaped esophagojejunostomy in totally laparoscopic total gastrectomy.
Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 6 patients with gastric cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between May 2016 and August 2016 were collected. All the 6 patients underwent totally laparoscopic total gastrectomy, operation procedures included esophagus and stomach mobilization, lymph node dissection, πshaped esophagojejunostomy, and then laparoscopic digestive tract reconstruction after jejunojejunal anastomosis. Observation indicators included: (1) surgical situations: conversion to open surgery, operation time, time of πshaped esophagojejunostomy, volume of intraoperative blood loss, number of lymph node dissected; (2) postoperative situations: time for initial outofbed activity, time of initial anal exsufflation, time of initial liquiddiet intake, time of abdominal drainage tube removal, postoperative complications and duration of postoperative hospital stay; (3) postoperative pathological examination; (4) followup and survival situations. Followup using outpatient examination was performed to detect the anastomotic stenosis, patients′ survival and tumor metastasis and recurrence up to November 2016. The measurement data with normal distribution were represented as ±s.
Results:(1) Surgical situations: all the 6 patients underwent successful totally laparoscopic total gastrectomy using the πshaped esophagojejunostomy, without conversion to open surgery and perioperative death. Operation time, time of πshaped esophagojejunostomy, volume of intraoperative blood loss and number of lymph node dissected were respectively (282±49)minutes, (37±9)minutes, (37±8)mL and 39±9. (2) Postoperative situations: time for initial outofbed activity, time of initial anal exsufflation, time of initial liquiddiet intake, time of abdominal drainage tube removal and duration of postoperative hospital stay of 6 patients were (44± 38)hours, (72±21)hours, (6.5±1.1)days, (11±7)days and (15±7)days, respectively. Six patients were not complicated with postoperative hemorrhage, duodenal stump fistula and death. One patient with anastomotic fistula was cured by abdominal puncture drainage under guidance of computed tomography (CT), enteral nutrition and antibiotic therapy, and then was discharged from hospital. (3) Postoperative pathological examination: pTNM staging showed that stageⅠA, ⅡA, ⅡB and ⅢA were detected in 3, 1, 1 and 1 patients, respectively. (4) Followup and survival situations: 6 patients were followed up for 3- 6 months, with a median time of 4 months. During followup, results of compound meglumine diatrizoate gastrointestinal radiography showed that there were smooth anastomoses, and no tumor recurrence or metastasis and death.
Conclusion:The πshaped esophagojejunostomy is safe and feasible in totally laparoscopic total gastrectomy.