Complete laparoscopic and Da Vinci robot esophagogastric anastomosis double muscle flap plasty for radical resection of proximal gastric cancer

Abstract

Objective: To investigate the application value of complete laparoscopy and Da Vinci robot esophagogastric anastomosis double muscle flap plasty in radical resection of proximal gastric cancer.

Method: A retrospective descriptive study was used. The clinicopathological data of 35 patients undergoing radical operation for proximal gastric cancer admitted to Liaoning Cancer Hospital from January 2020 to December 2023 were collected. Variables evaluated: 1. Transoperative,2. Postoperative, 3. Follow-up. In relation to follow-up, esophageal disease status reflux, anastomosis, nutritional status score, serum hemoglobin, tumor recurrence, and metastasis were investigated. The trans and postoperative variables were obtained from the clinical records and the patients were followed up in outpatient department and by telephone.

Result: Among the 35 patients, 17 underwent robotic surgery and 18 underwent laparoscopic surgery. There were 29 males and 6 females. 1) Transoperative: Robotic surgery: The operation time was (305.59 ± 22.07) min, the esophagogastric anastomosis double muscle flap plasty time was (149.76 ± 14.91) min, the average number of lymph nodes cleared was 30, and the average intraoperative blood loss was 30 ml. Laparoscopic surgery: The mean operation time was 305.17 ± 26.92min, the operation time of esophagogastric anastomosis double muscle flap was (194.06 ± 22.52) min, the average number of lymph nodes cleared was 24, and the average intraoperative blood loss was 52.5 ml. 2) Postoperative: Robotic surgery: the average time for patients to have their first postoperative anal emission was 3 days, the average time to first postoperative feeding was 4 days, and the average length of hospitalization after surgery was 8 days. Laparoscopic surgery: the average time for patients to have their first postoperative anal emission was 5 days, the average time to first postoperative feeding was 6 days, the average length of hospitalization after surgery was 10 days. 3) Follow-up: The follow-up time ranged from 1 to 42 months, with a median follow-up time of 24 months.

Conclusion: Complete Da Vinci robot and laparoscopic esophagogastric anastomosis double muscle flap plasty for radical resection of proximal gastric cancer can minimize surgical incision, reduce abdominal exposure, accelerate postoperative recovery of patients, and effectively prevent reflux esophagitis and maintain good hemoglobin concentration and nutritional status. The advantages of robotic surgery is less intraoperative bleeding and faster post-surgical recovery, but it is relatively more expensive.

Keywords: Da Vinci robot; complications; kamikawa anastomosis; laparoscopy; radical resection of proximal gastric cancer; stomach neoplasms; upper stomach.

Figure 1

(A) Trocar position in laparoscopic surgery (B) Trocar position in robotic surgery.

Figure 2

Proximal subtotal gastrectomy and lymph node dissection: (A) Dissecting the left gastro-omental artery and group 4sb lymph node dissection in laparoscopic surgery; (B) Dissecting the left gastro-omental artery and group 4sb lymph node dissection in Da Vinci robotic surgery; (C) Dissecting the short gatrie arteries and group 4sa lymph node dissection in laparoscopic surgery; (D) Dissecting the short gatrie arteries and group 4sa lymph node dissection in Da Vinci robotic surgery; (E) Group 2 lymph node dissection in laparoscopic surgery; (F) Group 2 lymph node dissection in Da Vinci robotic surgery; (G) Dissecting the left gastric artery and group 7, 8, 9 and 11p lymph node dissection in laparoscopic surgery; (H) Dissecting the left gastric artery and group 7, 8, 9 and 11p lymph node dissection in Da Vinci robotic surgery; (I) Group 1 lymph node dissection in laparoscopic surgery; (J) Group 1 lymph node dissection in Da Vinci robotic surgery; (K) Group 3a lymph node dissection in laparoscopic surgery; (L) Group 3a lymph node dissection in Da Vinci robotic surgery; (M) Separated from the esophagus, separated from the stomach in laparoscopic surgery; (N) Separated from the esophagus, separated from the stomach in Da Vinci robotic surgery.

Figure 3

Proximal gastrectomy Esophagogastric anastomosis double muscle flap plasty: (A) 3~4 cm away from the proximal stump of the stomach marked with an “H” shape, 2.5cm in width and 3.5cm in upper and lower spacing in laparoscopic surgery; (B) 3~4 cm away from the proximal stump of the stomach marked with an “H” shape, 2.5cm in width and 3.5cm in upper and lower spacing in Da Vinci robotic surgery; (C) double muscle flap made by laparoscopic surgery; (D) double muscle flap made by Da Vinci robotic surgery; (E) double muscle flap made by laparoscopic surgery; (F) double muscle flap made by Da Vinci robotic surgery; (G) The posterior wall of the esophagus and the stomach wall “H” shaped muscle flap across the upper side of the barb line continuous suture in laparoscopic surgery; (H) The posterior wall of the esophagus and the stomach wall “H” shaped muscle flap across the upper side of the barb line continuous suture in Da Vinci robotic surgery; (I) The whole posterior wall of the esophagus and the “H” -shaped transverse mucosa and submucosa of the residual stomach were sutured with barb line continuously in laparoscopic surgery; (J) The whole posterior wall of the esophagus and the “H” -shaped transverse mucosa and submucosa of the residual stomach were sutured with barb line continuously in Da Vinci robotic surgery; (K) The whole anterior wall of the broken end of the esophagus and the whole lower anal side of the residual stomach in the shape of “H” were sutured with barb line continuously in laparoscopic surgery; (L) The whole anterior wall of the broken end of the esophagus and the whole lower anal side of the residual stomach in the shape of “H” were sutured with barb line continuously in Da Vinci robotic surgery; (M) muscle layer reinforcement in laparoscopic surgery; (N) muscle layer reinforcement in Da Vinci robotic surgery; (O) The “H” shaped serosal muscle flap of the anterior wall of the stomach was used for “Y” shaped intermittent suture wrap around the anastomosis in laparoscopic surgery; (P) The “H” shaped serosal muscle flap of the anterior wall of the stomach was used for “Y” shaped intermittent suture wrap around the anastomosis in Da Vinci robotic surgery.

Figure 4

Postoperative upper gastrointestinal contrast study of the patient showed that the anastomosis was unobstructed.

Figure 5

Postoperative gastroscopy of the patient showed smooth esophageal mucosa and unobstructed anastomosis.