Umemura Akira, Koeda Keisuke, Sasaki Akira, Fujiwara Hisataka, Kimura Yusuke, Iwaya Takeshi, Akiyama Yuji, Wakabayashi Go
Department of Surgery, Iwate Medical University, Morioka, Japan.
Department of Surgery, Iwate Medical University, Morioka, Japan.
Asian J Surg. 2015 Apr;38(2):102-12. doi: 10.1016/j.asjsur.2014.09.006. Epub 2014 Nov 4.
There has been a recent increase in the use of totally laparoscopic total gastrectomy (TLTG) for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy (EJS) technique is the best. In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included. We analyzed the short-term results, relationships between EJS techniques and complications, long-term oncological results, and comparative study results of TLTG. TLTG was performed in a total of 1170 patients. The mortality rate was 0.7%, and the short-term results were satisfactory. Regarding EJS techniques and complications, circular staplers (CSs) methods were significantly associated with leakage (4.7% vs. 1.1%, p < 0.001) and stenosis (8.3% vs. 1.8%, p < 0.001) of the EJS as compared with the linear stapler method. The long-term oncological prognosis was acceptable in patients with early gastric cancers and without metastases to lymph nodes. Although TLTG tended to increase surgical time compared with open total gastrectomy and laparoscopy-assisted total gastrectomy, it reduced intraoperative blood loss and was expected to shorten postoperative hospital stay. TLTG is found to be safer and more feasible than open total gastrectomy and laparoscopy-assisted total gastrectomy. At present, there is no evidence to encourage performing TLTG for patients with advanced gastric cancer from the viewpoint of long-term oncological prognosis. Although the current major EJS techniques are CS and linear stapler methods, in this review, CS methods are significantly associated with leakage and stenosis of the EJS.
近年来，全腹腔镜全胃切除术（TLTG）在胃癌治疗中的应用有所增加。然而，尚无科学证据来确定哪种食管空肠吻合术（EJS）技术是最佳的。此外，TLTG的短期和长期肿瘤学结果并不一致。我们回顾了25篇关于TLTG治疗胃癌的文章，这些文章至少纳入了10例病例。我们分析了TLTG的短期结果、EJS技术与并发症之间的关系、长期肿瘤学结果以及比较研究结果。共有1170例患者接受了TLTG。死亡率为0.7%，短期结果令人满意。关于EJS技术与并发症，与直线切割吻合器方法相比，圆形吻合器（CS）方法与EJS的渗漏（4.7%对1.1%，p<0.001）和狭窄（8.3%对1.8%，p<0.001）显著相关。早期胃癌且无淋巴结转移患者的长期肿瘤学预后可以接受。尽管与开放全胃切除术和腹腔镜辅助全胃切除术相比，TLTG往往会增加手术时间，但它减少了术中失血，并有望缩短术后住院时间。TLTG被发现比开放全胃切除术和腹腔镜辅助全胃切除术更安全、更可行。目前，从长期肿瘤学预后的角度来看，没有证据支持对晚期胃癌患者进行TLTG。虽然目前主要的EJS技术是CS和直线切割吻合器方法，但在本综述中，CS方法与EJS的渗漏和狭窄显著相关。
