Jejunal Mesentery Preservation Reduces Leakage at Esophagojejunostomy After Minimally Invasive Total Gastrectomy for Gastric Cancer: a Propensity Score–Matched Cohort Study

Kubo, Naoshi; Sakurai, Katsunobu; Tamamori, Yutaka; Hasegawa, Tsuyoshi; Komatsu, Shuhei; Kuroda, Kenji; Murata, Akira; Kodai, Shintaro; Nishii, Takafumi; Tachimori, Akiko; Shimizu, Satoshi; Kanazawa, Akira; Inoue, Toru; Maeda, Kiyoshi; Nishiguchi, Yukio

doi:10.1007/s11605-022-05494-8

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…After cutting the jejunum at 20 cm from the ligament of Treitz, jejunojejunostomy was performed. The marginal vessels of the lifted-up jejunum were not cut during this reconstruction [21].…”

Section: Methodsmentioning

confidence: 99%

Study of Short-Term and Long-Term Outcomes Between Esophagogastrostomy and Double-Tract Reconstruction After Proximal Gastrectomy

Hasegawa,

Kubo,

Sakurai

et al. 2024

J Gastrointest Canc

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Background.As the opportunities for proximal gastrectomy (PG) for early gastric cancer in the upper third stomach have been increasing, the safety and feasibility of PG has been a great concern in recent years. This study aimed to compare to the short-term and long-term outcomes between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after PG. Methods.We retrospectively reviewed the medical records of 34 patients who underwent EG and 39 who underwent DTR at our hospital between 2011 and 2022. We compared the procedure data and postoperative complications including anastomotic complications within 1 year after surgery as short-term outcomes, and the rates of change in nutritional status, skeletal muscle mass, and 3-year survival as long-term outcomes. Results.Although operation time of DTR group was signi cantly longer than that of EG group, there were not signi cantly differences in postoperative complications between 2 groups. Regarding the endoscopic ndings, the incidence of anastomotic stenosis and re ux esophagitis was signi cantly higher in the EG group than in the DTR group (26.5% vs 0%; p < 0.001, 15.2% vs 0%; p = 0.020). In long-term outcomes, there were no signi cant differences in body weight, BMI, laboratory data, and skeletal muscle mass index between 2 groups for 3 years. The 3-year overall survival rates of 2 groups were similar. Conclusion.DTR after PG could prevent the occurrence of anastomotic complications in comparison to EG. The longterm outcomes were similar between these 2 types of reconstruction.

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Section: Methodsmentioning

confidence: 99%

Study of Short-Term and Long-Term Outcomes Between Esophagogastrostomy and Double-Tract Reconstruction After Proximal Gastrectomy

Hasegawa,

Kubo,

Sakurai

et al. 2024

J Gastrointest Canc

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“…• Preservation of mesentery of jejunum reduced the frequency of AL (1.4% vs. 13.0%, p=0.017) compared to dividing mesentery of jejunum group during laparoscopic gastrectomy [67].…”

Section: Reconstruction Type Eso-jejuno-anastomosismentioning

confidence: 95%

Anastomotic Leakage after Gastrectomy for Gastric Cancer

Seicean,

Puscasu,

Gheorghiu

et al. 2023

JGLD

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Anastomotic leakage (AL) constitutes a prominent cause of significant morbidity following gastrectomy for gastric cancer. The manifestation of AL typically occurs within 7 to 10 days post-surgery, with reported incidence rates of 5.8-6.7% for open gastrectomy and 3.3-4.1% for laparoscopic gastrectomy. Various predisposing risk factors have been identified, including the individual nutritional status (excluding obesity) and preoperative corticotherapy. Interestingly, the administration of neoadjuvant therapies appears to reduce the AL occurrence. In the context of distal gastrectomies, the rates of AL are comparable between laparoscopic, robotic, and open approaches. The total gastrectomies have higher AL rate compared to distal gastrectomies, which are considered the preferred approach. Prophylactic drainage measures have not demonstrated efficacy in preventing AL. As for postoperative management, conservative treatment is indicated for patients presenting with mild clinical symptoms and increased inflammatory blood tests. This approach involves fasting, enteral or parenteral nutrition, administration of antibiotics, and percutaneous drainage. For small AL, endoscopic therapies such as stents, vacuum therapy, clips, suturing devices, and injections are appropriate treatment options. In cases of high-volume fistulas, severe sepsis or failure of previous therapies, surgical reoperation becomes the ultimate solution.

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Study of Short-term and Long-term Outcomes between Esophagogastrostomy and Double-Tract Reconstruction after Proximal Gastrectomy.

Hasegawa,

Kubo,

Sakurai

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

Background. As the opportunities for proximal gastrectomy (PG) for early gastric cancer in the upper third stomach have been increasing, the safety and feasibility of PG has been a great concern in recent years. This study aimed to compare to the short-term and long-term outcomes between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after PG. Methods. We retrospectively reviewed the medical records of 34 patients who underwent EG and 39 who underwent DTR at our hospital between 2011 and 2022. We compared the procedure data and postoperative complications including anastomotic complications within 1 year after surgery as short-term outcomes, and the rates of change in nutritional status, skeletal muscle mass, and 3-year survival as long-term outcomes. Results. Although operation time of DTR group was significantly longer than that of EG group, there were not significantly differences in postoperative complications between 2 groups. Regarding the endoscopic findings, the incidence of anastomotic stenosis and reflux esophagitis was significantly higher in the EG group than in the DTR group (26.5% vs 0%; p < 0.001, 15.2% vs 0%; p = 0.020). In long-term outcomes, there were no significant differences in body weight, BMI, laboratory data, and skeletal muscle mass index between 2 groups for 3 years. The 3-year overall survival rates of 2 groups were similar. Conclusion. DTR after PG could prevent the occurrence of anastomotic complications in comparison to EG. The long-term outcomes were similar between these 2 types of reconstruction.

show abstract

Jejunal Mesentery Preservation Reduces Leakage at Esophagojejunostomy After Minimally Invasive Total Gastrectomy for Gastric Cancer: a Propensity Score–Matched Cohort Study

Cited by 3 publications

References 28 publications

Study of Short-Term and Long-Term Outcomes Between Esophagogastrostomy and Double-Tract Reconstruction After Proximal Gastrectomy

Study of Short-Term and Long-Term Outcomes Between Esophagogastrostomy and Double-Tract Reconstruction After Proximal Gastrectomy

Anastomotic Leakage after Gastrectomy for Gastric Cancer

Study of Short-term and Long-term Outcomes between Esophagogastrostomy and Double-Tract Reconstruction after Proximal Gastrectomy.

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