Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: A systematic review and meta-analysis

Guo, Zhi; Deng, Chun; Zhang, Zhenyu; Liu, Yang; Qi, Hengduo; Li, Xiaojun

doi:10.1016/j.ijsu.2022.106684

Cited by 14 publications

(13 citation statements)

References 42 publications

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“…Patients were screened strictly according to the following criteria: (1) Gastric adenocarcinoma was confirmed by postoperative pathological examination; (2) TNM stage I-III; (3) The patient informed consent and accepted TLTG+EJS; (4) The patient has complete clinical data (including endoscopy, CT, etc. ); (5) Tumor located in the gastric body or fundus. Exclusion criteria: (1) Conversion to laparotomy or small incision assisted anastomosis; (2) History of other malignant tumors; (3) Emergency operation; (4) Preoperative chemotherapy; (5) Follow-up time less than 6 months; (6) Serious organ dysfunction; (7) Lost to follow-up (Figure 1).…”

Section: Study Population and Groupingmentioning

confidence: 99%

“…Total gastrectomy is the preferred surgical procedure for tumors located in the middle or proximal part of the stomach (4). With the popularization and application of laparoscopic technique in GC, assisted laparoscopic total gastrectomy (LTG) has gradually transformed into totally LTG (TLTG) (5,6). The difficulty of this transformation lies in the reconstruction of the digestive tract under totally laparoscopy (7).…”

Section: Introductionmentioning

confidence: 99%

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Totally laparoscopic total gastrectomy with Uncut Roux-en-Y for gastric cancer may improve prognosis: A propensity score matching comparative study

et al. 2022

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BackgroundLaparoscopic total gastrectomy (LTG) with Roux-en-Y (RY) is often accompanied by a series of complications. Uncut RY (URY) can effectively reduce Roux stasis syndrome (RSS) in laparoscopic distal gastrectomy. To determine whether totally LTG (TLTG) with URY for gastric cancer (GC) can replace RY in short-term and long-term prognosis.MethodsThis comparative retrospective study selected GC patients from 2016 to 2022. The patients were divided into URY group and RY group. Cox multivariate proportional hazard regression analysis was used to explore the independent prognostic factors. Propensity score matching (PSM) was used to reduce bias.ResultsA total of 100 GC patients met the inclusion criteria. Compared to RY group, URY group showed significant advantages in operation time and length of hospital stay. In addition, URY group can significantly reduce short-term and long-term complications, especially RSS. The 1-, 3- and 5-year progression free survival (PFS) of URY group and RY group were 90.4% vs. 67.8% (P=0.005), 76.6% vs. 52.6% (P=0.009) and 76.6% vs. 32.8% (P<0.001), respectively. After PSM, the advantage of URY in PFS was verified again, while there was no significant difference in overall survival (OS) between the two groups. Cox multivariate analysis suggested that lower RSS was associated with better PFS.ConclusionsTLTG with URY for GC helps control disease progression, speed up recovery and reduce short and long-term complications, especially RSS.

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Section: Study Population and Groupingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Totally laparoscopic total gastrectomy with Uncut Roux-en-Y for gastric cancer may improve prognosis: A propensity score matching comparative study

et al. 2022

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“…• The overlap method of eso-jejuno-anastomosis (closure of anastomosis with a linear stapler, and double-stapling reconstruction of jejunojejunostomy) proved the same value as standard laparoscopic approach, using a 25-mm sized circular stapler via minilaparotomy, while jejunojejunostomy was performed in a hand-sewing manner (OR=1.23, p=0.50), with longer procedure duration [60] and lower incidence of anastomotic stenosis (OR=0.19, p<0.001) [61].…”

Section: Reconstruction Type Eso-jejuno-anastomosismentioning

confidence: 92%

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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“…Radical surgery is currently recommended for patients with initially operable gastric cancer (GC) [1][2][3][4]. With the innovation of laparoscopic instruments and the widespread application of minimally invasive technologies in GC [5,6], laparoscopy-assisted gastrectomy (LAG) has transitioned to totally laparoscopic gastrectomy (TLG) [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of totally laparoscopic gastrectomy with Uncut Roux-en-Y for gastric cancer: A dual-center retrospective study

Chen

Zheng

Tan

et al. 2023

Preprint

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Background Uncut Roux-en-Y (URY) effectively alleviates the common complications associated with RY, such as Roux-en-Y stasis syndrome (RSS). However, for gastric cancer (GC) patients, it is still controversial whether URY has an impact on long-term prognosis and whether it has fewer input loop recanalization. Therefore, compare whether URY and RY have differences in prognosis and long-term complications of GC patients undergoing totally laparoscopic gastrectomy (TLG). Methods We analyzed the data of patients who underwent TLG combined with digestive tract reconstruction from dual-center between 2016 and 2022. Only patients undergoing URY and RY were selected for analysis. Progression-free survival (PFS) and overall survival (OS) were estimated. Bias between the groups was reduced by propensity score matching (PSM). The Cox proportional hazard regression model was used to further analyze the influence of URY on prognosis. Results 242 GC patients were enrolled (retrospectively registered: IRB-2023-202). The URY had significantly shorter operation time, liquid food intake time, and hospital stays than the RY (P < 0.001). The URY had fewer long-term and short-term postoperative complications than the RY, especially with regard to RSS, reflux esophagitis, and reflux gastritis. The 3-year, and 5-year OS of the URY group and the RY group before PSM: 87.5% vs. 65.6% (P < 0.001), and 81.4% vs. 61.7% (P = 0.001). PSM and Cox multivariate analysis confirmed that compared to RY, URY can improve the short-term and long-term prognosis of GC patients. Conclusion TLG combined with URY for GC, especially for advanced, older, and poorly differentiated patients, can promote postoperative recovery, and improve long-term prognosis.

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Safety and effectiveness of overlap esophagojejunostomy in totally laparoscopic total gastrectomy for gastric cancer: A systematic review and meta-analysis

Cited by 14 publications

References 42 publications

Totally laparoscopic total gastrectomy with Uncut Roux-en-Y for gastric cancer may improve prognosis: A propensity score matching comparative study

Totally laparoscopic total gastrectomy with Uncut Roux-en-Y for gastric cancer may improve prognosis: A propensity score matching comparative study

Anastomotic Leakage after Gastrectomy for Gastric Cancer

Efficacy and safety of totally laparoscopic gastrectomy with Uncut Roux-en-Y for gastric cancer: A dual-center retrospective study

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