Abstract: Objective:To investigate the clinical efficacy of 2 types of anvil insertion techniques for esophagojejunostomy after laparoscopic total gastrectomy.
Methods:The clinical data of 18 patients with esophago gastric cancer and 14 patients with gastric cancer who were admitted to the Drum Tower Hospital from May 2011 to October 2012 were prospectively analyzed. After laparoscopic gastrectomy and D₂ lymph node dissection, all the patients were randomly divided into 2 groups according to the random number table. All the patients underwent esophagojejunostomy using the transorally inserted anvil (OrVil group, 7 patients with esophagogastric cancer and 9 patients with gastric cancer) or the hemi double stapling technique (HDST, HDST group, 11 patients with esophagogastric cancer and 5 patients with gastric cancer). Patients were followed up by phone call or out patient examination to learn the prognosis and dietary intake. The follow up was ended in December 2012. The measurement data and the count data were analyzed using the Student′s t test or Fisher exact probability.
Results:Laparoscopic total gastrectomy was successfully performed on all the 32 patients with no conversion to open surgery. The mean operation time, time for total gastrectomy and lymph node dissection and time for esophagojujunostomy were (303±51)minutes, (153±35)minutes, (57±15)minutes in the OrVil group, and (283±49)minutes, (160±31)minutes, (48±12)minutes in the HDST group, with no significant difference between the 2 groups (t=1.19, 0.59, 1.78, P>0.05). The time for stapler anvil insertion was (18±6)minutes in the OrVil group, which was significantly longer than (13±5)minutes in the HDST group (t=2.56, P<0.05). The intraoperative blood loss, number of lymph node dissected, length of incision, time for anal exhuast, time for out of bed activity, time for food intake and postoperative duration of hospital stay were (96±30)mL, 24±5, (3.7±0.4)cm, (3.4± 0.9)days, (3.9±0.7)days, (7.6±1.4)days, (10.4±1.6)days in the OrVil group, and (92±40)mL, 27±5, (3.6±0.6)cm, (3.3±1.0)days, (3.5±0.7)days, (8.3±3.0)days, (11.1±3.8)days in the HDST group, with no significant difference between the 2 groups (t=0.35, 0.01, 2.50, 0.37, 1.51, 0.82, 0.67, P>0.05). The distance between the incisal margin on proximal esophagus and the tumor was (3.1±0.5)cm in the OrVil group and (2.9±0.6)cm in the HDST group. No residual tumor, anastomotic stricture or bile reflux was observed in the 2 groups. Two patients were complicated with atelectasis, 1 with fat liquefaction of abdominal operative incision and 2 with postoperative anginosis in the OrVil group; 1 patient was complicated with pleural effusion, 1 with esophagojejunal anastomotic fistula, and they were cured by drainage or enteral nutrition in the HDST group. No feeding difficulty or reflux was observed. All the patients were followed up for 1-18 months, and the median time for follow up was 8 months. All the patients were survived with no regional recurrence or distal metastasis.
Conclusion:The 2 types of esophagojejunostomy can be performed under laparoscope, with no significant differences in safety and efficacy. HDST technique is faster and easier for the insertion of anvil when compared with OrVil.