Skip to main content

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

Surgical Endoscopy volume 30, pages 2396–2403 (2016)Cite this article

Abstract

Background

The purpose of this study is to depict a novel delta-shaped intracorporeal double-tract reconstruction (DT) for totally laparoscopic (TL) proximal gastrectomy (PG), and to evaluate its safety and feasibility by analyzing its surgical and postoperative outcomes.

Patients and methods

We retrospectively reviewed the cases of 21 patients who underwent TLPG and TLDT (TLPG-DT) from January to December 2014 in our hospital. The data of clinicopathologic characteristics, surgical and postoperative outcomes, and follow-up findings were collected and analyzed.

Results

The mean duration of the operation was 173.8 ± 21.8 min, including 27.8 ± 5.3 min of reconstruction. The blood loss was 109.2 ± 96.3 mL. The mean number of LNs dissected was 25.7 ± 4.7. The mean time of the first flatus was at postoperative day 2.3 ± 1.0, and the mean postoperative hospital stay was 6.8 ± 2.5 days. The early complications rate was 9.5 %, including one intraperitoneal hemorrhage and one pulmonary infection (both were managed through conservative methods and no re-operation occurred). The rate of complications in late stage was also 9.5 %, including one diarrhea and one reflux symptom claim. Among the total 21 cases, 17 patients were followed up more than 6 months, showing no signs of reflux esophagitis or anastomotic stenosis. The mean weight loss in 3 and 6 months after the operation was 4.3 and 5.7 %, respectively.

Conclusion

Totally laparoscopic delta-shaped intracorporeal double-tract reconstruction is a safe, feasible and minimally invasive reconstruction method with excellent postoperative outcomes in terms of preventing reflux esophagitis and anastomotic stenosis. TLPG-DT might serve as a promising treatment for proximal gastric cancer of early stage.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61:69–90

    Article  PubMed  Google Scholar 

  2. Sano T, Hollowood A (2006) Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg 95:249–255

    CAS  PubMed  Google Scholar 

  3. Saito T, Kurokawa Y, Takiguchi S, Mori M, Doki Y (2014) Current status of function-preserving surgery for gastric cancer. World J Gastroenterol 20(46):17297–17304

    Article  PubMed  PubMed Central  Google Scholar 

  4. Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I, Katai H, Tsujitani S, Kodera Y, Seto Y, Kaminishi M (2011) Gastric Cancer 14(4):301–316

    Article  PubMed  PubMed Central  Google Scholar 

  5. Takiguchi S, Masuzawa T, Hirao M, Imamura H, Kimura Y, Fujita J, Tamura S, Fujiwara Y, Mori M, Doki Y (2011) Pattern of surgical treatment for early gastric cancers in upper third of the stomach. Hepatogastroenterology 58:1823–1827

    Article  PubMed  Google Scholar 

  6. Masuzawa T, Takiguchi S, Hirao M, Imamura H, Kimura Y, Fujita J, Miyashiro I, Tamura S, Hiratsuka M, Kobayashi K, Fujiwara Y, Mori M, Doki Y (2014) Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg 38:1100–1106

    Article  PubMed  Google Scholar 

  7. An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S (2013) The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 196(4):587–591

    Article  Google Scholar 

  8. Nomura E, Lee SW, Kawai M, Yamazaki M, Nabeshima K, Nakamura K, Uchiyama K (2014) Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition. World J Surg Oncol 12:20

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tokunaga M, Ohyama S, Hiki N, Hoshino E, Nunobe S, Fukunaga T, Seto Y, Yamaguchi T (2008) Endoscopic evaluation of reflux esophagitis after proximal gastrectomy: comparison between esophagogastric anastomosis and jejunal interposition. World J Surg 32:1473–1477

    Article  PubMed  Google Scholar 

  10. Tokunaga M, Hiki N, Ohyama S, Nunobe S, Miki A, Fukunaga T, Seto Y, Sano T, Yamaguchi T (2009) Effects of reconstruction methods on a patient’s quality of life after a proximal gastrectomy: subjective symptoms evaluation using questionnaire survey. Langenbecks Arch Surg 394(4):637–641

    Article  PubMed  Google Scholar 

  11. Ahn SH, Jung do H, Son SY, Lee CM, Park do J, Kim HH (2014) Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer 17:562–570

    Article  PubMed  Google Scholar 

  12. Ikeguchi M, Kader A, Takaya S, Fukumoto Y, Osaki T, Saito H, Tatebe S, Wakatsuki T (2012) Prognosis of patients with gastric cancer who underwent proximal gastrectomy. Int Surg 97:275–279

    Article  PubMed  PubMed Central  Google Scholar 

  13. Nozaki I, Hato S, Kobatake T, Ohta K, Kubo Y, Kurita A (2013) Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg 37:558–564

    Article  PubMed  Google Scholar 

  14. Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T (2010) Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg 97:558–562

    CAS  Article  PubMed  Google Scholar 

  15. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

  16. Namikawa T, Oki T, Kitagawa H, Okabayashi T, Kobayashi M, Hanazaki K (2012) Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life: short- and long-term consequences. Am J Surg 204(2):203–209

    Article  PubMed  Google Scholar 

  17. Hiki N, Nunobe S, Kubota T, Jiang X (2013) Function-preserving gastrectomy for early gastric cancer. Ann Surg Oncol 20(8):2683–2692

    Article  PubMed  Google Scholar 

  18. Ohayama S, Tokunaga M, Hiki N, Fukunaga T, Fujisaki J, Seto Y, Yamaguchi T (2009) A clinicopathological study of gastric stump carcinoma following proximal gastrectomy. Gastric Cancer 12:88–94

    Article  Google Scholar 

  19. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148

    CAS  PubMed  Google Scholar 

  20. Lin JX, Huang CM, Zheng CH, Li P, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M (2015) Surgical outcomes of 2041 consecutive laparoscopic gastrectomy procedures for gastric cancer: a large-scale case control study. PLoS ONE. doi:10.1371/journal.pone.0114948

    Google Scholar 

  21. Kinoshita T, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T (2013) Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery. Surg Endosc 27:146–153

    Article  PubMed  Google Scholar 

  22. Ahn SH, Lee JH, Park do J, Kim HH (2013) Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer 16(3):282–289

    Article  PubMed  Google Scholar 

  23. Matsui H, Uyama I, Sugioka A, Fujita J, Komori Y, Ochiai M, Hasumi A (2002) Linear stapling forms improved anastomoses during esophagojejunostomy after a total gastrectomy. Am J Surg 184:58–60

    Article  PubMed  Google Scholar 

  24. Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287

    Article  PubMed  Google Scholar 

  25. Kim JJ, Song KY, Chin HM, Kim W, Jeon HM, Park CH, Park SM (2008) Totally laparoscopic gastrectomy with various types of intracorporeal anastomosis using laparoscopic linear staplers: preliminary experience. Surg Endosc 22:436–442

    Article  PubMed  Google Scholar 

  26. Morimoto M, Kitagami H, Hayakawa T, Tanaka M, Matsuo YL, Takeyama H (2014) The overlap method is a safe and feasible for esophagojejunostomy after laparoscopic-assisted total gastrectomy. World J Surg Oncol 12:392

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

    Affiliations

    1. Department of General Surgery, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China

      Jun Hong, Li Qian, Ya-Ping Wang, Jian Wang, Lu-Chun Hua & Han-Kun Hao

    Authors
    1. Jun Hong
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Li Qian
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Ya-Ping Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Jian Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Lu-Chun Hua
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Han-Kun Hao
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Han-Kun Hao.

    Ethics declarations

    Disclosures

    Drs. Jun Hong, Li Qian, Ya-Ping Wang, Jian Wang, Lu-Chun Hua and Han-Kun Hao have no conflicts of interest or financial ties to disclose.

    Additional information

    Jun Hong and Li Qian have equally contributed to this work and should be considered as co-first authors.

    Rights and permissions

    Reprints and Permissions

    About this article

    Verify currency and authenticity via CrossMark

    Cite this article

    Hong, J., Qian, L., Wang, YP. et al. A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy. Surg Endosc 30, 2396–2403 (2016). https://doi.org/10.1007/s00464-015-4490-5

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00464-015-4490-5

    Keywords

    • Totally laparoscopic proximal gastrectomy
    • Double-tract reconstruction
    • Delta-shaped anastomosis
    • Endoscopic linear stapler