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PubMed2006

[Laparoscopic-assisted radical gastrectomy: a report of 105 cases].

OBJECTIVE: To investigate the feasibility and safety of laparoscopic-assisted radical gastrectomy for gastric cancer. METHODS: One hundred and five patients with gastric cancer received laparoscopic-assisted radical gastrectomy, radical total gastrectomy were performed in 7 cases, proximal gastrectomy in 27 cases, proximal gastrectomy combined with splenectomy in 3 cases and distal gastrectomy in 68 cases. RESULTS: One hundred and five cases had laparoscopic-assisted radical gastrectomy successfully. The mean operation time was 381 +/- 91 (300 - 435) min for total gastrectomy, 279 +/- 73 (212 - 390) min for proximal gastrectomy, 312 +/- 64 (265 - 405) min for proximal gastrectomy combined with splenectomy, 281 +/- 69 (230 - 360) min for distal gastrectomy, respectively. The mean blood loss was 260 +/- 202 (20 - 900) ml in total gastrectomy, 200 +/- 153 (20 - 400) ml in proximal gastrectomy, 333 +/- 116 (200 - 400) ml in proximal gastrectomy combined with splenectomy, 140 +/- 82 (20 - 450) ml in distal gastrectomy, respectively. The mean number of harvested lymph nodes was 34.2 +/- 20.5 (8 - 83). The mean time for gastrointestinal function recovery was 3.5 +/- 1.4 (2 - 5) days, 3.0 +/- 1.6 (2 - 6) days for patients' taking normal activity, 4.9 +/- 1.7 (3 - 7) days for taking liquid food. The short-term efficiency was obvious. CONCLUSIONS: Laparoscopic-assisted radical gastrectomy is a feasible and safe surgical procedure combined with minimal trauma and fast recovery.

Adult↗
PubMed2005

[Laparoscopy-assisted radical gastrectomy: a report of 71 cases].

OBJECTIVE: To investigate the feasibility and safety of laparoscopy-assisted radical gastrectomy for gastric cancer. METHODS: Seventy-one patients with gastric cancer received laparoscopy-assisted radical gastrectomy for gastric cancer. Among them radical total gastrectomy was performed in 8 cases, proximal partial gastrectomy in 16 cases, proximal partial gastrectomy combined with splenectomy in 3 cases, and distal partial gastrectomy in 44 cases. RESULTS: Sixty-nine cases had laparoscopic-assisted surgery performed successfully, but 2 cases were converted to open surgery. The mean operation time was (343 +/- 52) min for total gastrectomy, (268 +/- 62) min for proximal gastrectomy, (312 +/- 64) min for proximal gastrectomy combined with splenectomy, and (283 +/- 44) min for distal gastrectomy respectively. The mean volume of blood loss was (267 +/- 220) ml in total gastrectomy, (150 +/- 103) ml in proximal gastrectomy, (333 +/- 116) ml in proximal gastrectomy combined with splenectomy, (139+/- 84) ml in distal gastrectomy respectively. The mean numbers of harvested lymph nodes were (34.3 +/- 11.8). The mean time was (4.1 +/- 1.1) d for gastrointestinal function recovery, (3.5 +/- 1.0) d for patient's taking general activity, (5.0 +/- 1.2) d for taking liquid food. The short-term efficiency was obvious. CONCLUSION: Laparoscopy-assisted radical gastrectomy is a feasible, safe and minimally invasive treatment and can achieve the same outcomes as the open operation.

Adult↗
PubMed1974

Elective total gastrectomy for cancer of the stomach: end results.

There has been no apparent improvement in overall salvage of patients with cancer of the stomach treated by elective extended total gastrectomy from 1950-1964 as compared with those treated by partial gastrectomy during the preceding 20-year period, 1931-1950 at Memorial Hospital in New York City. Criteria of resectability have been extended in recent years, and, therefore, the two series of patients cannot be considered strictly comparable. In the 94 patients subjected to elective total gastrectomy for cancer of the stomach, more than half (55 patients) had cancer in the proximal 1/3 of the stomach. The results obtained in this group by total gastrectomy are inferior to those obtained in the earlier series by partial gastrectomy. Patients with carcinoma of the mid 1/3 of the stomach showed essentially the same 5-year survival by elective total gastrectomy (34.8%) as by partial gastrectomy (33.5%), while those with carcinoma of the distal 1/3 of the stomach showed a greater 5-year survival by elective total gastrectomy (43.7%) than by partial gastrectomy (29.8%). However, of significance is the fact that the incidence of nodal metastasis was 3 times greater in the patients undergoing elective total gastrectomy than in those undergoing partial gastrectomy. Despite this unfavorable finding, 5-year survival in the patients undergoing elective total gastrectomy for carcinoma of the mid 1/3 or distal 1/3 of the stomach was equal to, or better than, that found in those undergoing partial gastrectomy for lesions similarly located. On the basis of this finding alone, we believe that elective total gastrectomy is a worthwhile endeavor and should be performed for operable carcinomas arising in the mid 1/3 or distal 1/3 of the stomach.

Adult↗
PubMed2006

What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus?

BACKGROUND: Tumours of the oesophagogastric junction and the gastric cardia can be treated either with proximal or with total gastrectomy. Reflux of bile and other duodenal contents into the oesophagus following proximal gastrectomy has generally been considered worse than reflux after total gastrectomy. The aim of the present study was to test this assumption given that there is limited literature regarding objective evaluation of the postoperative duodeno-oesophageal reflux. PATIENTS AND METHODS: We carried out bilirubin monitoring with the ambulatory spectrophotometer Bilitec 2000 in two groups of patients and in one group of healthy volunteers matched in age and sex. The proximal gastrectomy group consisted of 8 patients who underwent proximal gastrectomy and an end-to-side oesophagogastrostomy without pyloric drainage procedure. The total gastrectomy group consisted of 11 patients who underwent total gastrectomy and Roux-en-Y reconstruction with a 50-cm-long jejunal limb. The control group consisted of 8 healthy volunteers. In all cases, an absorption value of 0.14 was used as the threshold for reflux episodes. RESULTS: The median fraction of time that bilirubin absorbance was >0.14 in the proximal versus total gastrectomy group was 47.4 and 13.4%, respectively (p = 0.02). The difference between the two groups was significant in the supine position (p = 0.03), whilst the upright position, meal and postprandial periods were not found to have significant difference. Likewise, no significant difference was found in the number of reflux episodes. The median fraction of time in the proximal gastrectomy group compared with controls was 47.4 versus 3.95% (p < 0.001), whilst in the total gastrectomy group compared with controls, it was 13.4 versus 3.95% (p > 0.05). The number of reflux episodes in the proximal gastrectomy group compared with controls was 74 versus 21 (p = 0.02), whilst in the total gastrectomy group compared with controls, it was 103 versus 21 (p > 0.05). CONCLUSIONS: Total gastrectomy with Roux-en-Y reconstruction reduces the time of oesophageal exposure to duodenal juices as compared with proximal gastrectomy. This effect seems to be more prominent in the supine position.

Adult↗
PubMed2001

Evaluation of the cost for laparoscopic-assisted Billroth I gastrectomy.

BACKGROUND: Despite the rapid spread of laparoscopic gastric surgery in Japan, no one has yet evaluated the costs for this new technique. The aim of this study was to analyze and compare the hospital charges for laparoscopic-assisted gastrectomy with those for conventional open gastrectomy. METHODS: The study included 48 consecutive patients who underwent laparoscopic-assisted Billroth I gastrectomy and 43 who had a conventional open Billroth I gastrectomy for cure of early gastric cancer between May 1994 and April 2000. Hospital charges covered all costs incurred during the hospital stay; they were divided into charges for consultation, prescription, injection, nursing care, operating theater, laboratory, radiology, ward and meal, and others. RESULTS: The patients who underwent laparoscopic gastrectomy were similar to those who had open gastrectomy in terms of symptoms, concurrent illness, operation time, proximal resection margin, number of harvested lymph nodes, and stage of the disease. Hospital stay after laparoscopic gastrectomy was shorter than that after open gastrectomy (16.1 vs 20.5 days, p < 0.01). Charges for nursing care, charges for ward and meal, and total hospital charges were less in the laparoscopic group than in the open group ( yen5800 vs yen8010, p < 0.01; yen461 x 10(3) vs yen512 x 10(3), p < 0.05; yen1336 x 10(3) vs yen1411 x 10(3), p = 0.072). When we compared laparoscopic gastrectomies performed during 1994-96 with those done during 1997-2000, we found a decrease in charges for ward and meal and total hospital charges ( yen498 x 10(3) vs yen421 x 10(3), p < 0.01; yen1390 x 10(3) vs yen1277 x 103, p < 0.01). CONCLUSION: Laparoscopic-assisted Billroth I gastrectomy is less expensive than conventional open Billroth I gastrectomy because both the postoperative recovery period and the hospital stay are shorter. In patients who undergo gastrectomy, the additional costs of the disposable instruments can be fully offset by the lower charges for ward and meal and nursing care associated with laparoscopic gastrectomy.

Aged↗
PubMed1991

Nutritional status after total and partial gastrectomy with Roux-en-Y reconstruction.

Dietary intake and nutritional status were studied in two groups of patients after total gastrectomy (n = 10) and after partial gastrectomy (n = 10). All patients were reconstructed with a Roux-en-Y loop. Investigations were carried out 4-17 years after the operation. Eight patients in the group undergoing total gastrectomy and four patients undergoing partial gastrectomy had gastric carcinoma and were without recurrent disease 5-15 years after the operation. A clinical dietician conducted an anthropometric evaluation. All patients underwent an upper gastrointestinal endoscopy, clinical examination, [14C]triolein breath test and a blood chemistry profile. The median weight loss from operation to investigation was 2.1 kg in the partial gastrectomy group and 6.7 kg in the total gastrectomy group (n.s.). After partial gastrectomy three patients had a subnormal body mass index (n.s.). This was not found in the total gastrectomy group. Energy intake was below that recommended in seven patients in the partial gastrectomy group (three of them had a subnormal body mass index) and in two in the total gastrectomy group (n.s.) [14C]triolein breath testing revealed fat malabsorption in three patients after partial gastrectomy and in five patients after total gastrectomy (n.s.).

Adult↗
PubMedDate not supplied

Postoperative clinical evaluation following pylorus-preserving gastrectomy.

BACKGROUND/AIMS: Recent pathological study demonstrated that extended lymphadenectomy is not always necessary for patients with early gastric cancer. METHODOLOGY: Twenty-eight patients underwent pylorus-preserving gastrectomy. The clinicopathological findings of patients with pylorus-preserving gastrectomy were compared to those of 58 patients with conventional distal gastrectomy. RESULTS: There were no significant differences in surgical duration, blood loss, blood chemistry, food intake, and body weight loss. Regarding abdominal symptoms, early dumping syndrome was significantly higher in distal gastrectomy than in pylorus-preserving gastrectomy (35.6% vs. 12.0%, p<0.05). Remnant gastritis was also significantly higher in distal gastrectomy (57.1% vs. 27.7%, p<0.05). However, food residue tended to be more frequently seen in pylorus-preserving gastrectomy (33.3% vs. 61.1%, p=0.052). Based on questionnaire results, the rate of patient satisfaction with their surgical outcome tended to be lower in pylorus-preserving gastrectomy than in distal gastrectomy (84.0% vs. 95.6%, p=0.098). The tendency was more pronounced in patients over 70 years old (77.8% vs. 100%, p=0.065). CONCLUSIONS: Pylorus-preserving gastrectomy is superior to conventional distal gastrectomy in the prevention of dumping syndrome and reflux gastritis. However, since delayed emptying is frequently seen post pylorus-preserving gastrectomy, this procedure is not recommended for older patients under simplistic indications.

Female↗
PubMedDate not supplied

Esophageal manometric changes and gastroesophageal reflux symptoms after distal gastrectomy for gastric cancer.

BACKGROUND/AIMS: Gastroesophageal reflux is known to be a common complication after gastrectomy. However, its mechanism is not completely understood. We investigated the effects of distal gastrectomy for gastric cancer on the lower esophageal sphincter (LES) and esophageal motility. METHODOLOGY: In 18 patients who underwent distal gastrectomy reconstructed with Billroth I method for gastric cancer, esophageal motility and LES function were evaluated by means of a low-compliance manometric system. The LES pressure was determined by a rapid pull-through technique. Endoscopy before and after operation determined presence or absence of esophagitis and hiatus hernia. RESULTS: No significant differences were observed in esophageal contractile amplitudes before and after distal gastrectomy. After distal gastrectomy, five patients had reflux symptoms of heartburn and regurgitation; 11 had none. Endoscopy revealed esophagitis after distal gastrectomy in two patients with reflux symptoms and one patient without reflux symptoms. The LES pressure in patients with reflux symptoms decreased significantly after distal gastrectomy (before gastrectomy: 26.1 +/- 1.1 mmHg, after distal gastrectomy: 15.3 +/- 3.5 mmHg, p<0.05). There was no significant change in patients without reflux symptoms. CONCLUSIONS: This study demonstrated that LES pressure after distal gastrectomy in patients with reflux symptoms was significantly lower than that before gastrectomy. This result suggested that LES pressure decrease plays an important role in development of gastroesophageal reflux after distal gastrectomy reconstruction with the Billroth I method.

Esophageal Sphincter, Lower↗
PubMed2002

Esophageal cancer in patients with a history of distal gastrectomy.

HYPOTHESIS: There is an association between a history of distal gastrectomy and the development of esophageal cancer. Surgical treatment of esophageal cancer in patients with a history of gastrectomy is more complicated but will not result in increased mortality in an experienced center. DESIGN: Case-control study. SETTING: Tertiary care center for the treatment of esophageal cancer. PATIENTS: Forty patients with a history of gastrectomy and 1266 patients with intact stomachs who underwent esophagectomy for cancer. MAIN OUTCOME MEASURES: Patients' demographic characteristics, tumor characteristics, operative morbidity, mortality, and long-term survival. RESULTS: There were more squamous tumors located in the lower third of the esophagus in those who had a history of gastrectomy compared with those with intact stomachs (16 [41%] of 40 patients vs 318 [25%] of 1266 patients; P=.04). This difference was more pronounced after Billroth I vs Billroth II gastrectomy (8 [73%] of 11 patients vs 8 [29%] of 28 patients; P=.03). Twenty-four patients (60%) in the gastrectomy group and 738 (58%) in the nongastrectomy group underwent surgical resection (P=.87). The operative time (300 [160-465] vs 220 [90-520] minutes; P<.001) was longer and more blood loss (1000 [300-2500] vs 700 [150-7000] mL;P<.001) was encountered for esophagectomy after previous gastrectomy (data are given as median [range]). A colon interposition was the substitute conduit of choice in the gastrectomy group (20 [83%] of 24 patients), and the stomach was the preferred loop in those with intact stomachs (729 [99%] of 738 patients). Postoperative complication rates were similar. In-hospital mortality rates also did not differ for those with a history of gastrectomy vs those without such a history (12% for both,P>.99). Median survival after resection was 13.8 and 12.5 months for patients who did and did not undergo prior gastrectomy, respectively (P=.62). CONCLUSIONS: A history of gastrectomy (especially the Billroth I type) is associated with more lower-third squamous cell esophageal carcinomas. Surgical resections in patients with such a history were more complicated but resulted in similar outcomes.

Adenocarcinoma↗
PubMed2002

Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer.

Tumors in the upper one-third of the stomach has been increasing. Although the standard operation for proximal gastric cancer has been total gastrectomy, some have used proximal gastrectomy reconstructed by jejunum or gastric tube. The aim of this study was to evaluate the surgical results, hospital costs, and quality of life after gastrectomy for cancer. A consecutive series of 51 patients with stage I or II proximal gastric cancer was studied: 14 underwent proximal gastrectomy reconstructed by gastric tube (direct anastomosis between esophagus and remnant of tube-like stomach), 17 proximal gastrectomy reconstructed by jejunum, and 20 total gastrectomy in Roux-en-Y fashion. Quality of life was estimated by a 24-item questionnaire with a scoring system of 1 to 3, and hospital costs covered all charges during the hospital stay. Operating time, blood loss, and hospital stay for the gastric tube group were less than those for the jejunum group or the total gastrectomy group. Hospital charges for the gastric tube group were lower than those for the jejunum group or the total gastrectomy group (141 x 10 4 yen, 179 x 10 4 yen, 211 x 10 4 yen, respectively). Although the total score for quality of life was not significantly different among the three groups (35.9, 39.5, 37.6), the number of meals per day was less and the performance status was better in the gastric tube group. Jejunal interposition was less favorably accepted by the patients as a good operation they would recommend to others. The results indicate that, in patients with proximal gastric cancer, proximal gastrectomy reconstructed by gastric tube provides a shorter operating time, earlier recovery, lower hospital charge, and better performance status when compared with proximal gastrectomy reconstructed with jejunum or total gastrectomy.

Aged↗
PubMed2003

Subtotal versus total gastrectomy for T3 adenocarcinoma of the antrum.

BACKGROUND: The role of subtotal or total gastrectomy in the treatment of advanced gastric cancer of the antrum with serosal invasion was investigated. METHODS: The investigation involved 117 patients with a cancer of the lower third of the stomach invading the serosa (pT3) who underwent R0 resection with at least D2 lymphadenectomy between 1988 and 1998 at three different Italian centers. The choice of surgical procedure (40 total gastrectomies and 77 subtotal gastrectomies) was based on the preference of the surgeon; none of the patients underwent splenectomy. The Cox regression model was used to evaluate the prognostic significance of the type of surgery (subtotal versus total gastrectomy), controlling for age, sex, histology, nodal involvement, and surgical center. RESULTS: The morbidity and mortality rates did not vary significantly according to the type of surgery. Patients undergoing subtotal gastrectomy presented a better disease-related survival than patients undergoing total gastrectomy ( P = 0.011): the median survival times were, respectively, 38 months and 23 months, and the overall cumulative 5-year survival rates (95% confidence intervals [CI]) were, respectively, 36% (22%-50%) and 22% (11%-37%). On univariate analysis, the relative risk (RR) of disease-related death was 1.84 (1.14-2.97) after total gastrectomy, with respect to subtotal gastrectomy. This difference was blunted on multivariate analysis (RR, 1.66; 0.99-2.78): in the final model, only nodal metastasis was a significant prognostic factor, while type of surgery had a borderline significance ( P = 0.057). CONCLUSIONS: Survival after subtotal gastrectomy is not lower than that after total gastrectomy in patients with tumor of the antrum invading the serosa. The role of subtotal or total gastrectomy in the treatment of advanced gastric cancer of the antrum with serosal invasion was investigated.

Adenocarcinoma↗
PubMed2004

Prospective randomized study of two laparotomy incisions for gastrectomy: midline incision versus transverse incision.

BACKGROUND: We performed a randomized study to evaluate the differences between upper midline incision and transverse incision for gastrectomy. METHODS: Patients undergoing distal gastrectomy or total gastrectomy for gastric cancer were randomly allocated to have either an upper midline incision or a transverse incision. The times taken to open and close the abdominal cavity, the number of doses of postoperative analgesics, and the incidence of postoperative pneumonia, wound infection, and intestinal obstruction were compared between the patients having the two incisions. RESULTS: Times for both opening and closing the abdominal cavity were longer with a transverse incision, in both the distal gastrectomy group and total gastrectomy group. In the patients in whom continuous epidural analgesia was used postoperatively, the number of additional doses of analgesics was smaller in the transverse-incision group after distal gastrectomy. The incidence of postoperative pneumonia was lower in the transverse-incision group after distal gastrectomy. The number of patients with postoperative intestinal obstruction was smaller in the transverse-incision group than in the midline-incision group after distal gastrectomy. In contrast to distal gastrectomy, there was no significant difference in the number of doses of postoperative analgesics, incidence of postoperative pneumonia, or incidence of postoperative intestinal obstruction between the two study groups after total gastrectomy. CONCLUSION: A transverse incision for distal gastrectomy may be more beneficial than an upper midline incision in attenuating postoperative wound pain, decreasing the incidence of postoperative pneumonia, and preventing postoperative intestinal obstruction.

Aged↗
PubMedDate not supplied

The nutritional advantages of proximal gastrectomy for early gastric cancer.

BACKGROUND/AIMS: Total gastrectomy has generally been performed for the treatment of early gastric cancers involving the upper third of the stomach. However, proximal gastrectomy has also been used for the treatment of cardial early gastric cancer. METHODOLOGY: To compare the nutritional parameters after proximal gastrectomy with the parameters after total gastrectomy, and to also determine the advantages of the postoperative nutritional states, a retrospective analysis was made to evaluate the nutritional status of patients with early gastric cancer who underwent proximal gastrectomy with those undergoing total gastrectomy. Forty-nine patients were studied for one year after surgery; 9 underwent proximal gastrectomy while 40 had a total gastrectomy. RESULTS: Proximal gastrectomy allowed the patient to better maintain both their nutritional parameters and body weight. CONCLUSIONS: Proximal gastrectomy was thus found to be a beneficial modality for early gastric cancer patients regarding terms of the postoperative nutritional status, in comparison to total gastrectomy.

Aged↗
PubMedDate not supplied

Postoperative evaluation of the jejunal pouch reconstruction following proximal and distal gastrectomy for cancer.

BACKGROUND/AIMS: To evaluate the efficacy of the jejunal pouch reconstruction following subtotal proximal and distal gastrectomy, a retrospective study examining the postoperative condition of patients who underwent different methods of reconstruction after gastrectomy for cancer was undertaken. METHODOLOGY: Various parameters indicative of postoperative function were evaluated at one year postoperatively, and two major groups were examined. The "proximal gastrectomy" group was composed of patients who underwent either 1) proximal gastrectomy with an interposed jejunal pouch (PG-pouch), 2) proximal gastrectomy with simple jejunal interposition (PG-inter), or 3) total gastrectomy with simple jejunal interposition (TG). The "distal gastrectomy" group was composed of patients who underwent either 4) distal gastrectomy with an interposed jejunal pouch (DG-pouch), 5) distal gastrectomy with simple jejunal interposition (DG-inter), or 6) distal gastrectomy with Billroth 1 reconstruction (B-1). RESULTS: Volume of meal intake was better preserved and the incidence of abdominal symptoms were less frequent in the PG-pouch and DG-pouch groups. In the PG-inter, DG-inter and DG-pouch groups, none of the patients experienced heartburn or had endoscopic findings consistent with reflux esophagitis, while 2 patients (20.0%) in the PG-pouch group complained of heartburn with evidence of reflux esophagitis on endoscopy. Increase in blood acetaminophen level was milder in both the PG-pouch and DG-pouch groups, signifying improved gastric emptying. CONCLUSIONS: The jejunal pouch interposition following proximal and distal gastrectomy seems to confer clinical benefit in terms of postoperative function, especially in the form of meal intake, abdominal symptoms, and gastric emptying. The side effect of an improved reservoir may be the incidence of reflux esophagitis seen in 2 patients in the PG-pouch group.

Aged↗