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Totally laparoscopic distal gastrectomy with D2 lymphadenectomy and Billroth II gastrojejunostomy for gastric cancer: short- and medium-term results of 139 consecutive cases from a single institution.

Chen K, Xu X, Mou Y, Pan Y, Zhang R, Zhou Y, Wu D, Huang C - Int J Med Sci (2013)

Bottom Line: TLDG was successfully carried out in 139 patients; no cases were converted to open surgery.The 3-year disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 82.9%, respectively.When divided by stage, the 3-year DFS for stage I, II, and III were 100%, 86.2%, and 48.8%, respectively; and the 3-year OS for stage I, II, and III were 98.0%, 92.3%, and 51.6%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-invasive Surgery, Zhejiang University, Hangzhou, China.

ABSTRACT

Objective: The goal of this study was to investigate the feasibility, safety, and associated 3-year survival outcomes of the totally laparoscopic distal gastrectomy (TLDG) for the treatment of gastric cancer.

Methods: Herein, we analyzed the clinical data from 139 consecutive patients with gastric cancer who received TLDG at our institution from March of 2007 to March of 2013.

Results: TLDG was successfully carried out in 139 patients; no cases were converted to open surgery. The mean operation time was 228.6 ± 51.0 minutes, mean blood loss was 131.2 ± 85.2 mL, and mean number of dissected lymph nodes was 31.1 ± 9.0. The average time to flatus, time to fluid diet, and length of hospital stay were 3.6 ± 1.1 days, 4.8 ± 1.6 days, and 9.8 ± 4.0 days, respectively. The postoperative morbidity was 10.1%. A total of 135 patients were followed for a subsequent 1-73 months (median, 24.0 months). The 3-year disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 82.9%, respectively. When divided by stage, the 3-year DFS for stage I, II, and III were 100%, 86.2%, and 48.8%, respectively; and the 3-year OS for stage I, II, and III were 98.0%, 92.3%, and 51.6%, respectively.

Conclusions: In this preliminary report, TLDG was found to be a safe, feasible, and efficacious procedure for the treatment of gastric cancer with encouraging 3-year overall and stage-by-stage survival rates.

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Related in: MedlinePlus

Billroth II gastrojejunostomy as viewed through a laparoscope. A) Endoscopic linear stapler completing the anastomosis. B) Internal view of the anastomosis. C) Laparoscopically closed common opening sewn by hand. D) Completed gastrojejunostomy. Abbreviations: GR, gastric remnant; JE, jejunum; NG, nasogastric tube
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Figure 2: Billroth II gastrojejunostomy as viewed through a laparoscope. A) Endoscopic linear stapler completing the anastomosis. B) Internal view of the anastomosis. C) Laparoscopically closed common opening sewn by hand. D) Completed gastrojejunostomy. Abbreviations: GR, gastric remnant; JE, jejunum; NG, nasogastric tube

Mentions: The incision was sutured, and the pneumoperitoneum was reestablished. Two access openings were created: one on the antimesenteric side of the efferent jejunal (15-cm distal to the ligament of Treitz), and the other on the posterior wall of the gastric stump 2 cm towards the cutting margin. One of the endoscopic linear stapler (Endocutter 60 staple, Blue Cartridge; Ethicon, Endo-surgery, Cincinnati, OH) legs was inserted into the jejunum opening to draw the jejunum to the rear of the gastric stump. Then, the second leg was inserted into the stomach opening. After stapling, an antecolic Billroth II side-to-side gastrojejunostomy was constructed. The common opening was closed with a continuous 3-0 Vicryl suture (Fig. 2). A single drain was placed in the abdominal cavity through a 5-mm port on the patient's right side, and other port sites were closed (Fig. 3).


Totally laparoscopic distal gastrectomy with D2 lymphadenectomy and Billroth II gastrojejunostomy for gastric cancer: short- and medium-term results of 139 consecutive cases from a single institution.

Chen K, Xu X, Mou Y, Pan Y, Zhang R, Zhou Y, Wu D, Huang C - Int J Med Sci (2013)

Billroth II gastrojejunostomy as viewed through a laparoscope. A) Endoscopic linear stapler completing the anastomosis. B) Internal view of the anastomosis. C) Laparoscopically closed common opening sewn by hand. D) Completed gastrojejunostomy. Abbreviations: GR, gastric remnant; JE, jejunum; NG, nasogastric tube
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3775102&req=5

Figure 2: Billroth II gastrojejunostomy as viewed through a laparoscope. A) Endoscopic linear stapler completing the anastomosis. B) Internal view of the anastomosis. C) Laparoscopically closed common opening sewn by hand. D) Completed gastrojejunostomy. Abbreviations: GR, gastric remnant; JE, jejunum; NG, nasogastric tube
Mentions: The incision was sutured, and the pneumoperitoneum was reestablished. Two access openings were created: one on the antimesenteric side of the efferent jejunal (15-cm distal to the ligament of Treitz), and the other on the posterior wall of the gastric stump 2 cm towards the cutting margin. One of the endoscopic linear stapler (Endocutter 60 staple, Blue Cartridge; Ethicon, Endo-surgery, Cincinnati, OH) legs was inserted into the jejunum opening to draw the jejunum to the rear of the gastric stump. Then, the second leg was inserted into the stomach opening. After stapling, an antecolic Billroth II side-to-side gastrojejunostomy was constructed. The common opening was closed with a continuous 3-0 Vicryl suture (Fig. 2). A single drain was placed in the abdominal cavity through a 5-mm port on the patient's right side, and other port sites were closed (Fig. 3).

Bottom Line: TLDG was successfully carried out in 139 patients; no cases were converted to open surgery.The 3-year disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 82.9%, respectively.When divided by stage, the 3-year DFS for stage I, II, and III were 100%, 86.2%, and 48.8%, respectively; and the 3-year OS for stage I, II, and III were 98.0%, 92.3%, and 51.6%, respectively.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Institute of Micro-invasive Surgery, Zhejiang University, Hangzhou, China.

ABSTRACT

Objective: The goal of this study was to investigate the feasibility, safety, and associated 3-year survival outcomes of the totally laparoscopic distal gastrectomy (TLDG) for the treatment of gastric cancer.

Methods: Herein, we analyzed the clinical data from 139 consecutive patients with gastric cancer who received TLDG at our institution from March of 2007 to March of 2013.

Results: TLDG was successfully carried out in 139 patients; no cases were converted to open surgery. The mean operation time was 228.6 ± 51.0 minutes, mean blood loss was 131.2 ± 85.2 mL, and mean number of dissected lymph nodes was 31.1 ± 9.0. The average time to flatus, time to fluid diet, and length of hospital stay were 3.6 ± 1.1 days, 4.8 ± 1.6 days, and 9.8 ± 4.0 days, respectively. The postoperative morbidity was 10.1%. A total of 135 patients were followed for a subsequent 1-73 months (median, 24.0 months). The 3-year disease-free survival (DFS) and overall survival (OS) rates were 82.3% and 82.9%, respectively. When divided by stage, the 3-year DFS for stage I, II, and III were 100%, 86.2%, and 48.8%, respectively; and the 3-year OS for stage I, II, and III were 98.0%, 92.3%, and 51.6%, respectively.

Conclusions: In this preliminary report, TLDG was found to be a safe, feasible, and efficacious procedure for the treatment of gastric cancer with encouraging 3-year overall and stage-by-stage survival rates.

Show MeSH
Related in: MedlinePlus