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. 2022 Jan-Dec:29:10732748221087059.
doi: 10.1177/10732748221087059.

Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study

Yongjia Yan  1 , Daohan Wang  1 , Yubiao Liu  1 , Li Lu  1 , Xi Wang  1 , Zhicheng Zhao  1 , Chuan Li  1 , Jian Liu  1 , Weidong Li  1 , Weihua Fu  1
Affiliations

Optimal Reconstruction After Laparoscopic Distal Gastrectomy: A Single-Center Retrospective Study

Yongjia Yan et al. Cancer Control. 2022 Jan-Dec.

Abstract

Objectives: Although laparoscopic distal gastrectomy has been widely used for distal gastric cancer, the best functional reconstruction type has not yet been established. Based on previous experience, we propose a modified uncut Roux-en-Y anastomosis. This study aimed to compare the outcomes of different intracorporeal anastomoses after laparoscopic distal gastrectomy.

Methods: From April 2015 to August 2020, the data of 215 patients who underwent laparoscopic distal gastrectomy was collected. The patients were divided into 4 groups according to the digestive tract reconstruction method, Billroth-I, Billroth-II, Roux-en-Y, and the modified uncut Roux-en-Y. Clinicopathologic characteristics, surgery details, short-term outcomes, and postoperative nutritional status were analyzed.

Results: The operation time of Billroth-I anastomosis was significantly shorter (216.2 ± 25.8 min, P < .001) than that of other methods. There was no difference in postoperative complications and OS among the 4 reconstruction methods. The incidences of esophagitis, gastritis, and bile reflux were significantly lower in the Roux-en-Y and uncut Roux-en-Y group (P < .001) 1 year after surgery. And the postoperative albumin and PNI levels in uncut Roux-en-Y group were higher than those in other groups(P < .05). On multivariate analysis, age and reconstruction type were independently related to esophagitis, gastritis, and bile reflux. Serum albumin and the prognostic nutritional index were significantly higher in the uncut Roux-en-Y group than other groups (P < .05).

Conclusions: All 4 reconstruction techniques are feasible and safe. The Roux-en-Y and uncut Roux-en-Y are superior to Billroth-Ⅰ and Billroth-Ⅱ+Braun in terms of reflux esophagitis, gastritis, and bile reflux. Uncut Roux-en-Y may result in better PNI than the others.

Keywords: bile reflux; gastric cancer; laparoscopic surgery; nutrition; reconstruction.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Modified uncut Roux-en-Y operation. (A) Gastrojejunostomy is established approximately 20 cm distal to the ligament of Treitz. Occlusion is done at 3 cm proximal to the gastrojejunostomy. Jejunojejunostomy is done between the afferent and efferent jejunal limbs approximately 10 cm distal to the ligament of Treitz and 40 cm distal to the gastrojejunostomy site. (B) We performed1-0 silk seromuscular stitches circularly around the jejunal wall (b1), and provided reinforcement using interrupted seromuscular sutures at the occlusion site (b2). (C) Postoperative upper gastrointestinal radiography was done to determine afferent recanalization. This figure shows the results of the 4 patients who accepted uncut Roux-en-Y anastomosis.
Figure 2.
Figure 2.
Comparison of the survival curve in different groups. (A) The OS rate of the Billroth-I, Billroth-II+Braun, Roux-en-Y, and uncut Roux-en-Y anastomosis groups (P = .881). (B) The OS rate of TNM stages I, II, and III (P < .001). (C) The overall survival (OS) rate in patients with TNM stage I (P = .888). (D) The OS rate in patients with TNM stage II (P = .811). (E) The OS rate in patients with TNM stage III (P = .155).
Figure 3.
Figure 3.
Endoscopic findings and nutritional changes after laparoscopic distal gastrectomy in the 4 groups. (A) Endoscopic findings one year after surgery; (B) prognostic nutritional index (PNI); (C) albumin (g/L); (D) total lymphocyte count (109/L); (E) hemoglobin (mg/dL); and (F) total protein (g/L).
See this image and copyright information in PMC

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