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At least 19 recordsLinked to original sources
PubMedDate not supplied

The benefit of laparoscopy-assisted distal gastrectomy compared with conventional open distal gastrectomy: a case-matched control study.

BACKGROUND/AIMS: Laparoscopy-assisted distal gastrectomy is a surgical procedure which is safe, useful, and technically feasible for patients with early gastric cancer. The aim of this study is to determine whether laparoscopy-assisted distal gastrectomy is also superior to conventional open distal gastrectomy. METHODOLOGY: The study comprised 27 consecutive patients with early gastric cancer who were admitted to our hospital from 1997 to 2000 and underwent distal gastrectomy. Ten patients underwent laparoscopy-assisted distal gastrectomy; and 17 conventional open distal gastrectomy. RESULTS: Estimated blood loss was 17.7 +/- 12.1 g during laparoscopy-assisted distal gastrectomy, and 250.0 +/- 160.8 g during conventional open distal gastrectomy. The difference was statistically significant (p < 0.001). The day of ambulation (2.7 +/- 0.7 vs. 1.0 +/- 0.0), and start of liquid diet (6.9 +/- 1.2 vs. 4.3 +/- 0.5) were significantly delayed in conventional open distal gastrectomy compared with laparoscopy-assisted distal gastrectomy (p < 0.001, p < 0.05). At the 3rd postoperative day, the serum C-reactive protein level in laparoscopy-assisted distal gastrectomy decreased significantly more than that in conventional open distal gastrectomy (4.2 +/- 1.7 vs. 9.4 +/- 2.5: p < 0.05). No postoperative complication was found in laparaoscopy-assisted distal gastrectomy. CONCLUSIONS: Laparoscopy-assisted distal gastrectomy is a safe and useful operation for most early gastric cancers. Laparoscopy-assisted distal gastrectomy has been superior to conventional open distal gastrectomy.

Aged↗
PubMed2000

Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy.

BACKGROUND: Although several studies compare surgical results of laparoscopic and open colonic resections, there is no study of laparoscopic gastrectomy compared with open gastrectomy. HYPOTHESIS: When compared with conventional open gastrectomy, laparoscopy-assisted Billroth I gastrectomy is less invasive in patients with early-stage gastric cancer. DESIGN: Retrospective review of operative data, blood analyses, and postoperative clinical course after Billroth I gastrectomy. SETTING: University hospital in Japan. PATIENTS: The study included 102 patients who were treated with Billroth I gastrectomy for early-stage gastric cancer from January 1993 to July 1999: 49 with laparoscopy-assisted gastrectomy and 53 with conventional open gastrectomy. MAIN OUTCOME MEASURES: Demographic features examined were operation time; blood loss; blood cell counts of leukocytes, granulocytes, and lymphocytes; serum levels of C-reactive protein, interleukin 6, total protein, and albumin; body temperature; weight loss; analgesic requirements; time to first flatus; time to liquid diet; length of postoperative hospital stay; complications; proximal margin of the resected stomach; and number of harvested lymph nodes. RESULTS: Significant differences (P<.05) were present between laparoscopy-assisted and conventional open gastrectomy when the following features were compared: blood loss (158 vs 302 mL), leukocyte count on day 1 (9.42 vs 11.14 x 10(9)/L) and day 3 (6.99 vs 8.22 x 10(9)/L), granulocyte count on day 1 (7.28 vs 8.90 x 10(9)/L), C-reactive protein level on day 7 (2.91 vs 5.19 mg/dL), interleukin 6 level on day 3 (4.2 vs 26.0 U/mL), serum albumin level on day 7 (35.6 vs 33.9 g/L), number of times analgesics given (3.3 vs 6.2), time to first flatus (3.9 vs 4.5 days), time to liquid diet (5.0 vs 5.7 days), postoperative hospital stay (17.6 vs 22.5 days), and weight loss on day 14 (5.5% vs 7.1%). There was no significant difference between laparoscopy-assisted and conventional open gastrectomy with regard to operation time (246 vs 228 minutes), proximal margin (6.2 vs 6.0 cm), number of harvested lymph nodes (18.4 vs 22.1), and complication rate (8% vs 21%). CONCLUSIONS: Laparoscopy-assisted Billroth I gastrectomy, when compared with conventional open gastrectomy, has several advantages, including less surgical trauma, less impaired nutrition, less pain, rapid return of gastrointestinal function, and shorter hospital stay, with no decrease in operative curability. When performed by a skilled surgeon, laparoscopy-assisted Billroth I gastrectomy is a safe and useful technique for patients with early-stage gastric cancer.

Adenocarcinoma↗
PubMed2005

Laparoscopy-assisted total gastrectomy for early gastric cancer: comparison with conventional open total gastrectomy.

Laparoscopy-assisted distal gastrectomy has been applied to the treatment of early gastric cancer in Japan. So far, several studies about comparison between laparoscopy-assisted distal gastrectomy and conventional open distal gastrectomy were reported. However, there are few reports on the laparoscopy-assisted total gastrectomy, mainly because this procedure is performed relatively infrequently, and the procedure is more difficult than laparoscopy-assisted distal gastrectomy. This was a case-control study comparing between laparoscopy-assisted total gastrectomy group and open total gastrectomy group. From June 2001 to August 2004, laparoscopy-assisted total gastrectomy was performed in 20 patients. Reconstruction was performed by Roux-en-Y method or Roux-en-Y with jejunal pouch method through the mini-laparotomy. These cases were compared with 19 cases of open total gastrectomy, regarding operating time, blood loss, leukocyte count, C-reactive protein, time to the first passage of gas, time to initiate oral intake, and postoperative hospital stay.Laparoscopy-assisted total gastrectomy was successful in 20 patients. The mean operating time was 280 minutes and blood loss was 227.5 mL. Leukocyte counts on days 1, 3, and 7 were significantly lower in laparoscopic surgery group than in open surgery group. The time to first flatus, time to initiate oral intake, and postoperative hospital stay was significantly shorter (P < 0.05) in the laparoscopic surgery group than in the open surgery group. This study demonstrated that laparoscopy-assisted total gastrectomy is suitable and feasible for early gastric cancer and has the advantage of a shorter recovery time compared with open total gastrectomy.

Adenocarcinoma↗
PubMedDate not supplied

Comparative study between total gastrectomy and subtotal gastrectomy for treatment of gastric cancer.

The authors present a comparative study between subtotal and total gastrectomy with and without lymphadenectomy, analysing the morbidity and mortality as well as survival of the different groups, relating them to the site of the tumour and TNM staging. Two hundred and nine patients operated on for carcinoma of the stomach were analysed, 158 of whom corresponded to retrospective studies, 72 subtotal gastrectomies and 79 total gastrectomies with a mean 5-year survival of 16.66 and 16.76 months respectively. A comparison is made with the prospective group of 51 patients to whom total gastrectomy plus resection of the spleen and body and tail of the pancreas was performed, associated with regional lymphadenectomy relating lymph node spread with tumour location. The mortality rate for the three groups was 11.1% for subtotal gastrectomy, 11.1% for total gastrectomy and 7.8% for total gastrectomy plus lymphadenectomy. The mean survival rate in months shows no difference for stage I and is greater after gastrectomy plus lymphadenectomy in the remainder: 37.5% for stage II, 26.7% for stage III and 21.6% for stage IV. The cause of the difference is analysed and it is concluded that gastrectomy associated with lymph node resection performed by a trained team is the technique of choice for gastric cancer.

Adult↗
PubMed1984

[Carcinoma of the upper portion of the stomach; proximal partial gastrectomy or total gastrectomy].

Significance of proximal partial gastrectomy for carcinoma of the upper portion of the stomach is reported. The 5-year postoperative survival rate was 58% in patients receiving proximal partial gastrectomy while it was 61% in those undergoing total gastrectomy. With respect to stage III cancer cases, there was no difference in the 5-year postoperative survival between the 2 groups. Therefore, we suppose that proximal partial gastrectomy is a treatment of choice for patients with carcinoma of the upper portion of the stomach. Late postoperative laboratory examination showed less incidence of hyperchromic anemia in patients receiving proximal partial gastrectomy, and lowered serum vitamin B12 level was noted in patients undergoing total gastrectomy. Hypergastrinemia was found in patients receiving proximal partial gastrectomy, although its physiologic significance remains to be elucidated.

Cardia↗
PubMed2006

[Total gastrectomy of gastric stump carcinomas is more invasive than usual total gastrectomy for gastric carcinomas].

BACKGROUND: It is said that total gastrectomy of gastric stump carcinomas is more invasive than usual total gastrectomy for gastric carcinoma. METHODS: We compared the duration of the surgeries, blood loss, transfusion, and postoperative complications between patients having undergone total gastrectomy of gastric stump carcinomas (Group A, N=9) and those having undergone usual total gastrectomy for gastric carcinomas without remarkable preoperative complication (Group B, N=9). RESULTS: The surgical duration of Group A was significantly longer than that of Group B. The amount of blood loss was larger in Group A than in Group B. Postoperative severe complications occurred more often in Group A than in Group B. CONCLUSIONS: This study showes that total gastrectomy of gastric stump carcinomas is more invasive than usual total gastrectomy without preoperative complications. This seems to have been caused by adhesion of organs around the rest stomachs and carcinomas were very likely to be advanced ones in Group A. We should take the findings into considerations for maximum surgical blood order schedule (MSBOS) and prevention of severe postoperative complications in group A apart from group B.

Adult↗
PubMed1994

A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer.

OBJECTIVE: The authors determined if more radical surgery with extended lymphadenectomy improves the results of gastrectomy in patients with adenocarcinoma of the gastric antrum. SUMMARY BACKGROUND DATA: The overall survival in patients with gastric cancer is disappointing. Improved survival has been reported by Japanese authors. Whether this is because of a higher number of early gastric cancers in the Japanese series, different biologic behavior in Asians, or the adoption of radical surgery with lymphadenectomy remains unclear. METHODS: R1 subtotal gastrectomy with omentectomy and R3 total gastrectomy (omentectomy, splenectomy, distal pancreatectomy, lymphatic clearance of the celiac axis, and skeletonization of vessels in the porta hepatis) were evaluated in a prospective, randomized comparison. RESULTS: Fifty-five patients were randomized--25 to the R1 group and 30 to the R3 group. The two groups were comparable for age, sex, tumor size, TNM stage, and length of follow-up. The R3 group had a longer operating time (140 vs. 260 min; p < 0.05), a greater transfusion requirement (0 vs. 2 units, p < 0.05) and a longer hospital stay (8 vs. 16 days; p < 0.05) (medians; Mann-Whitney U test). The only postoperative death was in the R3 group and was caused by intra-abdominal sepsis. Fourteen patients in the R3 group developed left subphrenic abscesses. There were no major complications in the R1 group. Overall survival was significantly better in the R1 group (median survival estimated by Kaplan-Meier method, 1511 vs. 922 days, p < 0.05, log-rank test). CONCLUSIONS: R3 total gastrectomy can be performed with a low mortality, but it has a high morbidity because of intra-abdominal sepsis. The data do not support the routine use of R3 total gastrectomy for treatment of patients with antral cancer.

Adenocarcinoma↗
PubMed1992

[An experimental study on development of gallstone disease after curative gastrectomy for cancer--postoperative alteration of the composition of canine gallbladder bile after subtotal gastrectomy with truncal vagotomy].

In connection with gallstone (GS) formation after gastrectomy for cancer, we examined alteration of the composition of gallbladder bile after subtotal gastrectomy with truncal vagotomy. Of 11 mongrel dogs with cholecystostomy, 3 underwent B-I and 4 B-II gastrectomy. Four dogs without gastrectomy were served as controls. Bile was collected for 12 months. Bile acids were quantified by GLC. The bile was cultured for bacteriology. TBA did not significantly differ among the three groups of the dogs. In the two gastrectomized groups, CDA (a secondary bile acid) kept a higher level and CA (a primary bile acid) maintained a lower concentration compared with those in the controls. A remarkable increase of non-conjugated bile acids was recognized in both gastrectomized groups. Lithogenicity was low for all of the 3 groups. All but 1 control dog incurred bile infection that persisted long. Black pigment stones containing calcium bilirubinate developed in 1 of the 3 B-I and 2 of the 4 B-II dogs but none in the controls. The bile infection seemed to be involved in the development of GS. As the alteration of bile composition and GS occurred solely in the gastrectomized dogs, subtotal gastrectomy with truncal vagotomy might precipitate the GS formation.

Animals↗
PubMed1987

[Anastomotic fistula after gastrectomy. Diagnostic value of radiologic monitoring. Retrospective study of 123 gastrectomies].

In order to determine the usefulness of systematic radiological exploration after gastrectomy, 123 gastrectomies (39 total, 84 subtotal) performed over a 10-year period were reviewed. Control radiology had been carried out in 51% of the cases. Retrospectively, except for the lower percentage of total gastrectomies the two groups (with and without control radiology) were comparable. The overall incidence of fistula (9%) was similar to that found in the literature, bearing in mind that 90% of gastrectomies in this series were performed for cancer. The only two factors predictive of fistula were the presence of fever or of post-operative focal infection (P less than 0.001). It would appear that control radiology after gastrectomy is indicated only when post-operative fever is present. If this were done the number of useless examinations would be reduced and the cost-effectiveness ratio of radiology would be improved.

Female↗
PubMed1995

Electrogastrography prior to and following total gastrectomy, subtotal gastrectomy, and gastric tube formation.

On electrogastrography (EGG) spectral analysis, an activity of 3 cycles per minute (cpm) is supposed to be specific for the stomach. After total or subtotal gastrectomy, the original site of the stomach is occupied mainly by the intestine. We attempted to determine if intestinal activity could be recorded in this region with EGG. Epigastric recordings were performed in patients prior and following gastrointestinal or control surgeries. Spectral analysis, using the maximal entropy method and ensemble means was applied to data analysis from these recordings. Preoperatively, the majority of the power peaks were found around 3, 6, and 11 cpm. The postprandial-to-fasting power ratio of all of these power peaks increased significantly postprandially (P < 0.05-0.01). Following total gastrectomy, the power peak around 3 cpm disappeared or was significantly diminished in amplitude (P < 0.05). The postoperative-to-preoperative power ratio ranged from 0.03 to 0.10 (P < 0.001-0.01). However, the power peak around 11 cpm did not significantly change prior to or following total gastrectomy, and the 11 cpm peak appeared relatively dominant. Simultaneous manometric studies in the Roux limb demonstrated a correlation between the power spectral frequency of EGG and manometry at 11 cpm. Therefore, the 11 cpm peak appeared to reflect jejunal or Roux limb electrical activity. The postoperative to preoperative power ratio for the 3 cpm also was significantly reduced following subtotal gastrectomy and gastric tube formation in patients in the postprandial state (P < 0.05-0.001).

Adult↗
PubMed2002

Pylorus-preserving gastrectomy: effect on resistance through the sphincter of Oddi compared to conventional distal gastrectomy in dogs.

Bile stasis is an important etiologic factor in the high incidence of postgastrectomy gallstone disease (PGGD). Our previous study showed that duodenal, but not prepyloric, transection disturbed the motility of the sphincter of Oddi (SO) in anesthetized dogs. We had developed pylorus-preserving gastrectomy (PPG), in which the anal margin of the resected stomach is the prepyloric portion, not the duodenum. The present study evaluated the usefulness of PPG for reducing bile stasis, which may induce PGGD. We examined the resistance of bile flow through the SO using dogs that had undergone either PPG (n = 5) or conventional distal gastrectomy ( B-I) (n = 5). Four weeks after gastrectomy we anesthetized the animals and compared the basal and volume load-induced pressure in the common bile duct (CBD) between groups with or without administration of cholecystokinin-8 (CCK8). Flow resistance of the SO was evaluated by measuring flow volume through the SO following a graded pressure load to the CBD. The basal pressure and the threshold pressure to open the SO were significantly lower in PPG dogs than in B-I dogs independent of CCK8 administration. There were no significant differences between groups in regard to volume load-induced pressure elevation or the resistance of the SO. These results indicate that PPG may be more useful for reducing the incidence of PGGD than conventional distal gastrectomy, possibly through attenuating resistance to bile flow.

Animals↗
PubMed2006

Comparative study of laparoscopy-assisted distal gastrectomy and open distal gastrectomy.

BACKGROUND: Most studies comparing surgical results of laparoscopic procedures for gastric cancer with open gastrectomies have been conducted based on limited experience. We aimed to compare laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) after a protracted learning experience. STUDY DESIGN: We retrospectively reviewed medical records data. Two hundred fifty six patients underwent distal gastrectomies (136 LADG, 120 ODG). There were 150 early gastric cancer (EGC) patients (120 LADG, 30 ODG). RESULTS: Mean operation times for LADG and ODG were similar among EGC (156.5 versus 159.3 minutes, p = 0.666). Mean retrieved lymph node counts for LADG and ODG were different, but were > 30 (31.3 versus 40.4 for all and 30.4 versus 38.1 for EGC). For all subjects or EGC patients after LADG, C-reactive proteins on day 5 were substantially lower, first liquid diet was resumed substantially sooner, and postoperative hospital stays were substantially shorter than for ODG. CONCLUSIONS: LADG with lymph node dissection after a learning curve has several advantages compared with ODG, namely, less inflammatory reaction, rapid return of gastrointestinal function, and shorter hospital stay without compromising operation time or operative curability.

Female↗
PubMed2002

A prospective randomized study comparing D2 total gastrectomy versus D2 total gastrectomy plus splenectomy in 187 patients with gastric carcinoma.

BACKGROUND: Classic surgical treatment of upper third gastric carcinoma is based on an extended total gastrectomy, including splenectomy. The purpose of this study was to perform a prospective randomized clinical trial comparing the early and late results of total gastrectomy (TG) versus total gastrectomy plus splenectomy (TGS). METHODS: One hundred eighty-seven patients with gastric carcinoma were included. In all patients a D2 total gastrectomy was performed. During surgery they were randomized to 1 of 2 operative options. They were monitored to their death or to 5 years later if they were alive. RESULTS: Operative mortality was similar after both operations (3% after TG and 4% after TGS). Septic complications after surgery were higher after TGS compared with TG (P <.04). Five-year survival rates were not statistically different between groups or in subset analysis according to stage of disease. CONCLUSIONS: On the basis of the results of the present prospective randomized trial, splenectomy is not necessary in early stages of disease. A low operative mortality rate (less than 3%) must be achieved to obtain good long-term results.

Adult↗
PubMed1991

Pylorus and antroseromuscular flap-preserving gastrectomy--a new type of reconstruction after subtotal gastrectomy for treatment of gastroduodenal ulcer: clinical and experimental study.

To avoid motility disturbances after Billroth gastrectomy, the authors designed pylorus and antroseromuscular flap-preserving subtotal gastrectomy (PAFPG). Results showed that gastric motility and emptying time of dogs after PAFPG were close to normal. PAFPG was applied to 125 consecutive patients with gastroduodenal ulcers (gastric ulcer, 15 patients; duodenal ulcer, 94 patients; and combined ulcers, 16 patients) confirmed by barium examination and fibro-gastroendoscopy. All patients recovered smoothly, none of them had postoperative complication. Gastric acid output reduction rates were as follows: basal acid output, 85.05% +/- 8.13%; maximal acid output, 81.76% +/- 10.85%; peak acid output, 81.42% +/- 10.15%. The incidence of postoperative enterogastric reflux (endoscopically) and the concentration of cholic acids in gastric juice were significantly lower in patients after PAFPG than after Billroth I or II gastrectomy. Results suggest that PAFPG reduced gastric acid outputs definitely and overcame adverse motility consequences after Billroth I or II gastrectomy desirably.

Animals↗
PubMed1995

Adenocarcinoma of the gastric antrum: does D2 total gastrectomy with splenectomy improve prognosis compared to D1 subtotal gastrectomy? A long-term survival analysis with emphasis on Lauren classification.

AIMS: The purpose of this retrospective study was to evaluate whether a more radical resection, including total gastrectomy (TG), D2 lymphadenectomy and splenectomy, or subtotal gastrectomy (SG), improves the prognosis of patients with an adenocarcinoma located on the distal third of the stomach. PATIENTS AND METHODS: Seventy-four consecutive patients with an antral carcinoma underwent gastric resection. Forty-three had a TG and 31 an SG. D2 lymph node dissection was carried out in 70% of all patients (30/43) and 100% (21/21) of patients with curative resection in the TG group, whereas in the SG group the patients had only a standard D1 lymph node dissection. Splenectomy was carried out in 84% (36/43) of patients in the TG group, whereas in the SG group the spleen was preserved in all patients. Follow-up was complete for 100% of the patients, with a median follow-up time of 74 months. MAIN END-POINTS OF INTEREST: Overall survival rates, mortality and morbidity rates. RESULTS: The postoperative 30-day mortality rate was 7% in the TG group and 3.2% in the SG group. The overall morbidity rate was increased from 19% after SG to 37% after TG. There was no microscopic evidence of involvement of proximal resection margins in any of 31 subtotal resected gastric specimens. Lymph node metastases to the splenic hilus (no. 10 nodes) or along the splenic artery (no. 11 nodes) were not found in any of 36 patients who underwent splenectomy and lymphadenectomy. The 5- or 10-year survival rates did not differ significantly between both groups. Analysis of survival showed no significant difference between the TG and SG groups when related to subgroups of patients with curative resection (UICC-RO resection), nodal status (pN), tumour depth (pT-category), tumour stage (pTNM), or Lauren classification (intestinal or diffuse type of carcinoma). The survival rates for patients with curative resection after 5 or 10 years were 58% in the TG group and 66% or 51% in SG group, respectively (P = 0.66). CONCLUSION: Since D2 total gastrectomy carried an increased overall morbidity risk and did not improve survival in patients with intestinal or diffuse type carcinoma, it seems that with regard to luminal gastric resection, SG is the treatment of choice for carcinomas located in the distal third of the stomach. Whether extensive radical D2 lymphadenectomy should be routinely performed in addition to SG is still controversial.The spleen should be preserved in most cases.

Adenocarcinoma↗
PubMed2004

Electrogastrographic activity in patients who received proximal gastrectomy plus jejunal interposition or total gastrectomy plus jejunal interposition.

Electrogastrograms (EGGs) were recorded in patients both before and after receiving proximal gastrectomy plus jejunal interposition (PGJI) or just after receiving total gastrectomy plus jejunal interposition (TGJI). Intraluminal pressure was also recorded in some postoperative patients. The EGG 3 cpm component (2.5-4.9 cpm) remained after PGJI, but subsequently decreased with a significant reduction in the preoperative to postoperative ratio of the 3 cpm components (P<0.05). The mean frequency of the 3 cpm components increased significantly after PGJI (P<0.05) and its instability factor increased. The EGG 10 cpm components became relatively dominant compared to other frequency components in 2 out of 8 of patients having PGJI but the mean amplitude of 10 cpm decreased. In TGJI patients, only the 10 cpm component was conspicuous in EGG as in the case of total gastrectomy and Roux en Y anastomosis procedures. The spectral frequencies of intraluminal pressure in the interposed jejunum were similar to the EGG of 10 cpm components both in the case of PGJI and TGJI patients. In conclusion, surface EGG could record the electrical activities of the interposed jejunum more easily in patients having had TGJI than in PGJI.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

Gastric emptying rate for solid and for liquid test meals in patients with dyspeptic symptoms after partial gastrectomy and after vagotomy followed by partial gastrectomy.

BACKGROUND/AIMS: Gastric emptying rate for solid and for liquid test meals was investigated retrospectively in patients with longstanding epigastric distress after partial gastrectomy, either as primary treatment or after failure of vagotomy for peptic ulcer in order to find an explanation for the postoperative symptoms. METHODOLOGY: Radionuclide-labeled liquid and solid test meals were used to evaluate gastric emptying rate, at least one year after surgery. RESULTS: The lag phase for liquid test meals disappeared in all operated patients. Partial gastrectomy usually lead to fast emptying but this resective procedure, if performed after vagotomy, lead to stasis in a significant number of patients. Gastric emptying rate for solids increased in only a few of these symptomatic patients. In most of them however, there was a normal to decreased emptying rate. If a vagotomy had preceded the resective procedure, gastric emptying rate decreased significantly. CONCLUSIONS: In all these symptomatic patients, gastric emptying had been disturbed for at least one type of test meal. This makes investigation for both meals necessary, especially since there is a lack of correlation. Furthermore, if vagotomy fails to prevent ulcer recurrence, one should carefully consider all options before performing partial gastrectomy since gastric emptying rate after these consecutive procedures worsens considerably.

Adult↗