Objective To explore the pain after discharged in patients with radical total gastrectomy under painless ward management, and to analyze the causes of pain in order to guide the treatment strategy after discharge. Methods Retrospective analysis was performed on the pain data of 82 patients who underwent radical total gastrectomy in The First Affiliated Hospital of Air Force Military Medical University from December 2015 to April 2017, and the situation of pain was followed-up at 2 weeks, 1 month, 2 months, and 3 months after discharged. Results Mild pain occurred in 25 patients at the 2 weeks after discharged; mild pain occurred in 38 patients and moderate pain occurred in7 patients at the first month after discharged; mild pain occurred in 31 patients and moderate pain occurred in 4 patients at the second month after discharged; 19 patients had mild pain at the third month after discharged. There was no significant difference in pain scores between male patients and female patients, <60 years old patients and ≥60 years old patients, patients’ operative time<180 min and patients’ operative time ≥180 min, patients’ intraoperative blood loss<200 mL and patients’ intraoperative blood loss ≥200 mL at the all time points, including the second week, the first, the second, and the third month after discharge ( P>0.05). Conclusion Painless ward management can effectively control the degree of pain in discharged patients who underwent radical total gastrectomy.
Objective To evaluate the effect of total gastrectomy (TG) and proximal gastrectomy (PG) for the treatment of advanced esophagogastric junction cancer. Methods Clinical data of 273 cases of advanced esophagogastric junction cancer who underwent TG and PG in our hospital from Jan. 2004 to Dec. 2010 were reviewed for retrospective analysis. Operation related indexes, 3-year cumulative survival rate, and 5-year cumulative survival rate were compared and evaluated. Results There was no significant difference between TG group and PG group in intraoperative blood loss, operation time, and hospital stay(P > 0.05), but the number of dissected lymph nodes in TG group was obviously more than those of PG group, and the difference was statistically significant(P=0.000). The postoperative complication rates were 10.3%(12/117)in TG group and 21.8%(34/156) in PG group respectively, which was lower in TG group(χ2=6.353, P < 0.05). The 3-year and 5-year cumulative survival rates of TG group were 58.9% and 34.2%, of PG group were 43.4% and 23.6% respectively, and the 3-year and 5-year cumulative survival rates were all lower in PG group(χ2=5.894, P < 0.05;χ2=5.582, P < 0.05). For patients in stage pT4, pN2, and TNMⅢ, whose tumor size were bigger than 3.0 cm, and patients who had accept chemotherapy, the 3-and 5-year cumulative survival rates of TG group were significantly higher than those of PG group(P < 0.05). However, for patients in stage pT2, pT3, pN0, pN1, pN3, TNMⅠ, TNMⅡ, TNMⅣ, whose tumor size were smaller than 3.0 cm, who had not accept chemotherapy, and patients of any pathological type, there was no statistically significant difference between the 2 groups in 3-year and 5-year cumulative survival rates(P > 0.05). Conclusion For the patients who suffered from advanced esophagogastric junction cancer, TG can improve long-term survival rate, and it can significantly reduce the incidence of postoperative complications and improve postoperative quality of life.
Objective To investigate for a reasonable reconstruction method in patients undergoing total gastrectomy. Methods Data of 63 cases receiving total gastrectomy from January 2000 to October 2005 in Ganzhou District Hospital of Zhangye City were analyzed retrospectively, and the patients were divided into double pouch jejunum interposition （DPJI） group (n=30) and Roux-en-Y ρ pouch （RYρ） group (n=33) according to the operation methods, then operation time， morbidity of complications, amount and frequency of meat and drink, complications of digestive tract, amount of total protein and albumin were compared between two groups. Results There were no significant differences in operation time，morbidity of complications, the amount or frequency of meat and drink between two groups (Pgt;0.05); but the incidence of digestive tract complications of DPJI group was lower than that of RYρ group （P＜0.05). GradeⅠ/Ⅱof Vervaeck index and the amount of total protein and albumin in DPJI group were statistical significantly higher than those of RYρ group （P＜0.05）. Conclusion Functional DPJI is a reasonable digestive tract reconstruction method.
Objective To compare short-term effects of totally laparoscopic total gastrectomy (TLTG) and laparoscopic assisted total gastrectomy (TATG) in treatment of resectable gastric cancer. Methods The EMbase, PubMed, The Cochrane Library, Web of Science, CBM, CNKI, and WanFang Data databases were searched by computer. According to the inclusion and exclusion criteria of the literatures, the comparative research literatures were selected. The relevant data were extracted and the literature evaluation was applied. The Revman 5.3 software was applied for the meta-analysis. Results A total of 11 articles (6 Chinese literatures, 5 English literatures) were included, including 1 491 patients clinically diagnosed with the gastric cancer. The results of meta-analysis showed: compared with the LATG group, the TLTG group had the less intraoperative blood loss ［MD=–17.59, 95% CI (–30.81, –4.37), P=0.009］, shorter incision length ［MD=–4.50, 95% CI (–4.92, –4.09), P<0.000 01］, and earlier first anal exhaust time ［MD=–0.16, 95% CI (–0.28, –0.04), P=0.007］in the treatment of gastric cancer; Besides, the first time of postoperative fluid intake of the TLTG group was earlier ［MD=–0.47, 95% CI (–0.86, –0.08), P=0.02］ and the postoperative hospital stay of the TLTG group was shorter ［MD=–0.59, 95% CI (–0.94, –0.24), P=0.000 9］; In the TLTG group, the VAS score was lower on the first postoperative day ［MD=–3.10, 95% CI (–3.48, –2.72), P<0.000 01］ and on the third postoperative day ［MD=–2.30, 95% CI (–2.57, –2.03), P<0.000 01］. There were no significant differences in the operation time, proximal margin distance, distal margin distance, lymph node dissection, and postoperative adverse reactions between the two groups (P>0.05). The subgroup analysis of the postoperative adverse reactions showed that there were no significant differences in the anastomotic stricture, anastomotic leakage, and anastomotic bleeding (P>0.05). Conclusions TLTG has some advantages of less bleeding, shorter incision, earlier ventilation and feeding, shorter postoperative hospital stay, and light postoperative pain in treatment of resectable gastric cancer. However, due to quantitative and qualitative limitations of included studies, above conclusions still need to be carried out more and high quality researches are validated.
Objective To summarize the research progress of digestive tract reconstruction after total gastrectomy in gastric cancer. Methods The domestic and international published literatures about digestive tract reconstruction after total gastrectomy in gastric cancer were retrieved and reviewed. Results More and more attention had been paid to the postoperative quality of life after total gastrectomy in gastric cancer， and the most related factor for postoperative quality of life was the type of digestive tract reconstruction. The pouch reconstruction and preservation of enteric myoneural continuity showed beneficial effects on clinical outcomes. Current opinion considered the pouch reconstruction might be safe and effective， and was able to improve the postoperative quality of life of patients with gastric cancer. However， the preservation of duodenal pathway didn’t show significant benefits. Conclusion The optimal digestive tract reconstruction after total gastrectomy is still debating， in order to resolve the controversies， needs more in-depth fundamental researches and more high-quality randomized controlled trials.
Objective To find out some ideal reconstructions after total gastrectomy in experimental study of rat. Methods Sixty male Sprague-Dawley rats were randomly and averagely divided into 6 groups: Roux-en-Y group (RY group), proximate jejunal pouch group (PJP group), distal jejunal pouch group (DJP group), two jejunal pouchs group (TJP group), duodenumjejunal pouch interposition group (DJPI group) and laparotomy group (L group). Body weight of rats, intestinal transit distance, adaptive changes in esophagojejunostomic mucosa and morphology changes of intestine after operation were observed and compared. Results At 2 weeks after operation, body weight in each group were significantly lower than that before operation （P＜0.05）. At 4 weeks postoperatively, body weight in PJP group, TJP group and DJPI group were significantly higher than that in RY group respectively （P＜0.05）, as well as at 8 weeks. Intestinal transit distance in PJP group was shorter than that in RY group （P＜0.05）. With regard to intestinal mucosa, TJP group and DJPI group were significantly different with RY group （P＜0.05）. Interestingly, there was no difference in each group as to refluxing esophagitis （P＞0.05）. Conclusion Proximate and two jejunal pouchs Roux-en-Y esophagojejunostomy seem to be ideal procedures for digestive tract reconstruction after total gastrectomy. The jejunal pouch interposition procedure seems to be same effective to PJP and TJP, but there is no preponderance over the former.
ObjectiveTo analyze the risk factors affecting the postoperative ileus after total gastrectomy in elderly patients with gastric cancer. MethodsThe elderly patients with gastric cancer after total gastrectomy admitted to the Second Department of General Surgery of Shaanxi Provincial People’s Hospital from January 2015 to December 2020 were retrospectively collected and the postoperative ileus was analyzed. Meanwhile the risk factors affecting the postoperative ileus after total gastrectomy in the elderly patients with gastric cancer were analyzed using univariate and multivariate logtistic regression analyses. ResultsA total of 306 elderly patients with gastric cancer who met the inclusion and exclusion criteria of this study were collected, 33 (10.8%) of whom suffered the postoperative ileus after surgery. The results of multivariate logtistic regression analysis showed that the preoperative anemia [OR (95%CI)=2.740 (1.181, 6.356), P=0.019], preoperative complicated intestinal obstruction [OR (95%CI)=3.286 (1.208, 8.935), P=0.020], open operation [OR (95%CI)=3.753 (1.298, 10.848), P=0.015], and operative time ≥400 min [OR (95%CI)=3.902 (1.705, 8.925), P=0.001] increased the risk probability of postoperative ileus after total gastrectomy in the elderly patients with gastric cancer. ConclusionsAccording to the analysis results of this study, the preoperative anemia and complicated intestinal obstruction, as well as the adopted open surgery and operation time ≥400 min are the risk factors of postoperative ileus in elderly patients with gastric cancer after total gastrectomy. When total gastrectomy is chosen for elderly patients with gastric cancer, preoperative physical status needs to be adjusted, such as correcting anemia and removing preoperative intestinal obstruction. During operation, the operation modus should be prior to the minimally invasive surgery according to the individual conditions of elderly patients and the operation skills of surgeons should be improved so as to reduce postoperative ileus.
ObjectiveTo evaluate the safety and efficacy of transorally inserted anvil (OrVilTM) for laparoscopic total gastrectomy compared with open total gastrectomy.MethodsRetrospectively summarized the 285 gastric cancer patients from the Affiliated Hospital of Xuzhou Medical University between December 2012 and April 2018, of them 156 patients underwent laparoscopic total gastrectomy (being reconstructed by OrVilTM) via 129 patients underwent open total gastrectomy. Operation-associated parameters and postoperative complications were compared between the two groups.ResultsThe intraoperative blood loss was significantly less, proximal resection margin was significantly longer, and first ambulatory time, time to first flatus, time to fluid diet were significantly shorter in the laparoscopic total gastrectomy group (P<0.05). Whereas the total operative time, esophagojejunostomy time, numbers of dissected lymph nodes, time to remove drainage tube, length of postoperative hospital stay, and morbidity of postoperative complication (including anastomotic leakage, anastomotic stenosis, anastomotic bleeding, celiac and pleural effusion or infection) were not significantly different between the two groups (P>0.05).ConclusionOrVilTM is a technically safe and feasible surgical procedure for esophagojejunostomy in laparoscopic total gastrectomy.