Abstract: Objective:To investigate the safety and feasibility of the reversed π-shaped esophagojejunal anastomosis in laparoscopeassisted total gastrectomy (LATG) for gastric cancer (GC).
Methods:The retrospective corsssectional study was conducted. The clinicopathological data of 18 GC patients who were admitted to the Subei People′s Hospital of Jiangsu Province between January 2015 and October 2016 were collected. All the 18 GC patients underwent LATG, surgical procedures included free stomach and lymph node dissection firstly, sidetoside jejunal anastomosis secondly and laparoscopic gastrointestinal reconstruction using reversed π-shaped anastomosis finally. Observation indicators : (1) surgical situations: sidetoside jejunal anastomosis method, conversion to open surgery, operation time, reversed π-shaped anastomosis time, volume of intraoperative blood loss and number of lymph node dissected; (2) postoperative situations: time for initial outofbed activity, time to initial anal exsufflation, time for postoperative water intake, time of drainage tube removal, postoperative complications and duration of hospital stay; (3) postoperative pathological examination; (4) followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect diet intake, anastomosis patency, gastrointestinal obstruction and patients′ survival up to March 2017. Measurement data with normal distribution were represented as ±s.
Results:(1) Surgical situations: 18 patients underwent successful LATG and reversed π-shaped esophagojejunal anastomosis, without conversion to open surgery and perioperative death. Five patients used in vitro handsewn sidetoside esophagojejunal anastomosis through small incision of specimens sampling, and 13 completed all surgery under laparoscopy. Operation time, reversed π-shaped anastomosis time, volume of intraoperative blood loss and number of lymph node dissected of 18 patients were (187±12)minutes, (37±5) minutes, (735±18)mL and 29±2, respectively. (2) Postoperative situations: time for initial outofbed activity, time to initial anal exsufflation, time for postoperative water intake and time of drainage tube removal in 18 patients were (1.6±0.5) days, (2.3±0.4) days, (2.5±0.5) days and (7.5± 1.5)days, respectively. One patient complicated with esophagojejunal anastomosis fistula at postoperative day 3 was cured by drainage and symptomatic treatment and then discharged from hospital. Eighteen patients received regularly angiography using oral watersoluble contrast medium after recovering fluid diet intake, showing anastomosis patency and no contrast medium leakage, and then discharged from hospital. Duration of hospital stay of 18 patients was (12±11)days. (3) Postoperative pathological examination: of 18 patients, 15 were diagnosed with adenocarcinoma and 3 with signetring cell carcinoma. T2, T3 and T4 of T staging were respectively detected in 3, 3 and 12 patients. N0, N1, N2 and N3 of N staging were respectively detected in 8, 3, 2 and 5 patients. Stage Ⅰ，Ⅱ and Ⅲ of TNM stage were detected in 3, 5 and 10 patients, respectively. (4) Followup and survival situations: 17 of 18 patients were followed up for 6-25 months, with a median time of 12 months. During the followup, 2 patients were complicated with sour regurgitation and vomiting after eating at month 6 and 12 postoperatively and received gastrointestinal contrast examination, showing anastomotic stenosis, and then were cured by endoscopic dilation and discharged form hospital. Other patients had good diet and survival, without anastomotic complications.
Conclusion:The reversed π-shaped esophagojejunal anastomosis in LATG for GC is safe and feasible, with good shortterm outcomes.