scholarly journals Various Kinds of Functional Digestive Tract Reconstruction Methods After Proximal Gastrectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Shuaibing Lu ◽  
Fei Ma ◽  
Zhandong Zhang ◽  
Liangqun Peng ◽  
Wei Yang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Digestive Tract ◽  
Proximal Gastrectomy ◽  
Perioperative Outcomes ◽  
Reconstruction Method ◽  
Proximal Gastric Cancer ◽  
Reconstruction Methods

The incidence of proximal gastric cancer has shown a rising trend in recent years. Surgery is still the main way to cure proximal gastric cancer. Total gastrectomy with D2 lymph node dissection was considered to be the standard procedure for proximal gastric cancer in the past several decades. However, in recent years, many studies have confirmed that proximal gastrectomy can preserve part of the stomach function and can result in a better quality of life of the patient than total gastrectomy. Therefore, proximal gastrectomy is increasingly used in patients with proximal gastric cancer. Unfortunately, there are some concerns after proximal gastrectomy with traditional esophagogastrostomy. For example, the incidence of reflux esophagitis in patients who underwent proximal gastrectomy with traditional esophagogastrostomy is significantly higher than those patients who underwent total gastrectomy. To solve those problems, various functional digestive tract reconstruction methods after proximal gastrectomy have been proposed gradually. In order to provide some help for clinical treatment, in this article, we reviewed relevant literature and new clinical developments to compare various kinds of functional digestive tract reconstruction methods after proximal gastrectomy mainly from perioperative outcomes, postoperative quality of life and survival outcomes aspects. After comparison and discussion, we drew the conclusion that various functional reconstruction methods have their own advantages and disadvantages; large scale high-level clinical studies are needed to choose an ideal reconstruction method in the future. Besides, in clinical practice, surgeons should consider the condition of the patient for individualized selection of the most appropriate reconstruction method.

scholarly journals Novel Reconstruction Using Roux-en-Y Plus Antral Obstruction Following Proximal Gastrectomy: Feasibility and Quality of Life Benefits

2019 ◽  
Author(s):  
Dejun Yang ◽  
Changming Wang ◽  
Hongbing Fu ◽  
Ziran Wei ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Partial Gastrectomy ◽  
Incidence Rates ◽  
Reconstruction Method ◽  
Reflux Symptoms ◽  
Reconstruction Methods ◽  
Postoperative Reflux

Abstract Background and Aims Routine gastroesophagostomy has been shown to have adverse effects on the recovery of digestive functions and quality of life because patients typically experience reflux symptoms after proximal gastrectomy. This study was performed to assess the feasibility and quality of life benefits of a novel reconstruction method termed Roux-en-Y anastomosis plus antral obstruction (RYAO) following proximal partial gastrectomy. Methods A total of 73 patients who underwent proximal gastrectomy from June 2015 to June 2017 were divided into two groups according to digestive reconstruction methods [RYAO (37 patients) and conventional esophagogastric anastomosis with pyloroplasty (EGPP, 36 patients)]. Clinical data were compared between the two groups retrospectively. Results The mean operative time for digestive reconstruction was slightly longer in the RYAO group than in the EGPP group. However, the incidence of postoperative short-term complications did not differ between the RYAO and the EGPP groups. At the 6-month follow-up, the incidence rates of both reflux esophagitis and gastritis were lower in the RYAO group than in the EGPP group (P = 0.002). Additionally, body weight recovery was better in the RYAO group (P = 0.028). The scale tests indicated that compared with the patients in the EGPP group, the patients in the RYAO group had significantly reduced reflux, nausea and vomiting and reported improvements in their overall health status and quality of life (all P < 0.05). Conclusion RYAO reconstruction may be a feasible procedure to reduce postoperative reflux symptoms and the incidence of reflux esophagitis and gastritis, thus improving patient quality of life after proximal gastrectomy.

scholarly journals Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 1-13
Author(s):  
Lulu Zhao ◽  
Rui Ling ◽  
Jinghua Chen ◽  
Anchen Shi ◽  
Changpeng Chai ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Early Gastric Cancer ◽  
Total Gastrectomy ◽  
Meta Analysis ◽  
Proximal Gastrectomy ◽  
Perioperative Outcomes ◽  
Proximal Gastric Cancer ◽  
Term Survival

<b><i>Introduction:</i></b> The extent of optimal gastric resection for proximal gastric cancer (PGC) continues to remain controversial, and a final consensus is yet to be met. The current study aimed to compare the perioperative outcomes, postoperative complications, and overall survival (OS) of proximal gastrectomy (PG) versus total gastrectomy (TG) in the treatment of PGC through a meta-analysis. <b><i>Methods:</i></b> We systematically searched PubMed, Embase, The Cochrane Library, and Web of Science for articles published in English since database establishment to October 2019. Evaluated endpoints were perioperative outcomes, postoperative complications, and long-term survival outcomes. <b><i>Results:</i></b> A total of 2,896 patients in 25 full-text articles were included, of which one was a prospective randomized study, one was a clinical phase III trial, and the rest were retrospective comparative studies. The PG group showed a higher incidence of anastomotic stenosis (OR = 2.21 [95% CI: 1.08–4.50]; <i>p</i> = 0.03) and reflux symptoms (OR = 3.33 [95% CI: 1.85–5.99]; <i>p</i> &#x3c; 0.001) when compared with the TG group, while no difference was found in PG patients with double-tract reconstruction (DTR). The retrieved lymph nodes were clearly more in the TG group (WMD = −10.46 [95% CI: −12.76 to −8.17]; <i>p</i> &#x3c; 0.001). The PG group was associated with a better 5-year OS relative to TG with 11 included studies (OR = 1.35 [95% CI: 1.03–1.77]; <i>p</i> = 0.03). After stratification for early gastric cancer and PG with DTR groups, however, there was no significant difference between the 2 groups (OR = 1.35 [95% CI: 0.59–2.45]; <i>p</i> = 0.62). <b><i>Conclusion:</i></b> In conclusion, PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups. Future randomized clinical trials of esophagojejunostomy techniques, such as DTR following PG, are expected to prevent postoperative complications and assist surgeons in the choice of surgical approach for PGC patients.

Reconstruction Methods and Complications in Proximal Gastrectomy for Gastric Cancer, and a Comparison with Total Gastrectomy

2014 ◽  
Vol 61 (1.2) ◽  
pp. 23-29 ◽  
Author(s):  
TARO ISOBE ◽  
KOUSUKE HASHIMOTO ◽  
JUNYA KIZAKI ◽  
SATORU MATONO ◽  
NAOTAKA MURAKAMI ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Proximal Gastrectomy ◽  
Reconstruction Methods

scholarly journals Radiographic study of patients submitted to total gastrectomy using Safatle reconstruction technique

2008 ◽  
Vol 45 (3) ◽  
pp. 230-233
Author(s):  
Alberto Luiz Monteiro Meyer ◽  
Eduardo Berger ◽  
Orlando Monteiro Jr. ◽  
Paulino Alberto Alonso ◽  
João Sadi Lerner
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Total Gastrectomy ◽  
Gastrointestinal Transit ◽  
Jejunal Loop ◽  
Reconstruction Technique ◽  
Resected Stomach ◽  
Radiographic Study ◽  
Drainage Time

BACKGROUND: Ever since the first total gastrectomy, there has always been a great concern in increasing the survival of patients, and with the advance of techniques, in improving the quality of life of these patients. The most common reconstruction technique of the gastrointestinal transit is the Roux-en-Y. The reposition of a functional pouch in place of the resected stomach was proposed to minimize the postprandial symptoms, improve the nutritional grade and consequently, the quality of life. The Safatle reconstruction of the gastrointestinal transit technique consists of, in short, in the association of the interposition of the jejunal loop with partial transit through the duodenum, with an inverted Roux-en-Y and with the creation of a pouch which resembles the dynamics of the stomach, achieved by duodenojejunal segment which has an antiperistalsis emptying. AIM: To assess, by radiographic means, the emptying of the duodenojejunal pouch in patients submitted to total gastrectomy using the Safatle reconstruction technique. METHOD: Twelve patients submitted to total gastrectomy using the Safatle technique due to gastric cancer were studied. They were summoned to perform contrasted radiographies of the esophagus-duodenum-jejunum by the videofluoroscopic method during the months of July and August, 2005. RESULTS: All the patients presented satisfactory movement of the duodenojejunal pouch and an adequate emptying in antiperistalsis without food stasis. There has been an average 25-minute drainage time of the duodenojejunal pouch. CONCLUSION: The duodenojejunal pouch, in the patients submitted to total gastrectomy using the Safatle reconstruction, presented adequate emptying and movement.

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