Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life

Abstract

AIMTo evaluate the short-term outcomes and quality of life (QoL) in gastric cancer patients undergoing digestive tract construction using the isoperistaltic jejunum-later-cut overlap method (IJOM) after totally laparoscopic total gastrectomy (TLTG).METHODSA total of 507 patients who underwent laparoscopic gastrectomy (D2) from January 2014 to March 2016 were originally included in the study. The patients were divided into two groups to undergo digestive tract construction using either IJOM after TLTG (group T, n = 51) or Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy (LATG) (group A, n = 456). The short-term outcomes and QoL were compared between the two groups after 1:2 propensity-score matching (PSM). We used a questionnaire to assess QoL.RESULTSBefore matching, age, sex, tumor size, tumor location, preoperative albumin and blood loss were significantly different between the two groups (P < 0.05). After PSM, the patients were well balanced in terms of their clinicopathological characteristics, although both blood loss and in-hospital postoperative days in group T were significantly lower than those in group A (P < 0.05). After matching, group T reported better QoL in the domains of pain and dysphagia. Among the items evaluating pain and dysphagia, group T tended to report better QoL (“Have you felt pain” and “Have you had difficulty eating solid food”) (P < 0.05).CONCLUSIONThe IJOM for digestive tract reconstruction after TLTG is associated with reduced blood loss and less pain and dysphagia, thus improving QoL after laparoscopic gastrectomy.

Short-term Outcomes of Totally Laparoscopic Versus Laparoscopy-assisted Total Gastrectomy for Gastric Cancer: a Systematic Review and Meta-analysis

“…However, we could not perform subgroup analysis according to IEJ styles due to the limitation of sample size. Because the IEJ can be di cult, some researchers believe that TLTG was associated with longer operation time [27]. In this meta-analysis, the operation time for TLTG was shorter than LATG.…”

“…This might be attributed to TLTG does not need additional mini-laparotomy. Meanwhile, blood vessels in the muscles and mesentery can be more readily identi ed and are less likely to be transacted during the IEJ [27]. Moreover, the esophageal stump should be pulled out from the abdominal cavity when EEJ is performed.…”

“…Finally, 8 non-randomized controlled studies were eligibly included in the pooled analysis [20][21][22][23][24][25][26][27]. The detailed search steps are presented in Fig.…”

“…2B). 6 studies reported estimated blood loss [21][22][23][24][25]27]. Estimated blood loss was signi cantly lower in the TLTG group compared with the LATG group (WMD=-42.35 ml; 95% CI, -74.61 to -10.10; P = 0.01) (Fig.…”

Impact of Esophagojejunal Reconstruction without Division of the Mesentery for Total Laparoscopic Total Gastrectomy

“…Therefore, many investigators have performed TLTG using various surgical instruments and approaches. The standard procedure for EJ anastomosis has not been established to date [ 6 7 8 9 10 ].…”