Cai Zheng-Hao, Zang Lu, Yang Han-Kwang, Kitano Seigo, Zheng Min-Hua
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Minimally Invasive Surgery Center, Shanghai, China.
Asian J Endosc Surg. 2017 Aug;10(3):259-267. doi: 10.1111/ases.12362. Epub 2017 Feb 10.
Laparoscopic total gastrectomy (LTG) has been widely performed for gastric cancer in China, Korea, and Japan. The current status of this surgical approach needs to be investigated.
During the 11th China-Korea-Japan Laparoscopic Gastrectomy Joint Seminar in Shanghai, China, on 5 March 2016, a questionnaire was completed by 65 experts in LTG. The survey included questions on surgical indication, operation team, laparoscopic instruments, and operative procedures.
Of the 65 respondents, 35 (53.8%) were from China, 18 (27.7%) were from Korea, and 12 (18.5%) were from Japan. Surgeons have various indications for LTG. Among respondents, stage II gastric cancer (42.9%) was the most acceptable indication, but Japanese surgeons were more cautious on this issue (P = 0.005). Using a flexible scope was more popular with Japanese surgeons than with others (P = 0.003). A goose-neck curved grasper was used more often in China and Korea than in Japan (P = 0.006). Chinese surgeons preferred vertical subxiphoid mini-laparotomy rather than vertical transumbilical laparotomy. Intracorporeal reconstruction (73.0%) was most frequently adopted for LTG. Linear staplers (53.8%) and circular staplers (42.1%) were both popular for esophagojejunostomy. However, jejunojejunostomy was more often conducted extracorporeally (67.7%), in which case a linear stapler (86.4%) was usually selected. Significant differences were observed between the three countries with regard to reinforcement of the duodenal stump (P = 0.018) and closure of Peterson's space (P < 0.001).
This survey on LTG involving surgeons from China, Korea, and Japan clearly informed the current practice of this surgical approach and will likely aid future research studies as well as clinical treatment for gastric cancer.
腹腔镜全胃切除术（LTG）在中国、韩国和日本已广泛应用于胃癌治疗。这种手术方式的现状需要进行调查。
在2016年3月5日于中国上海举行的第十一届中日韩腹腔镜胃癌联合研讨会上，65位LTG专家完成了一份调查问卷。调查内容包括手术适应症、手术团队、腹腔镜器械和手术操作程序等问题。
65位受访者中，35位（53.8%）来自中国，18位（27.7%）来自韩国，12位（18.5%）来自日本。外科医生对LTG有不同的适应症。受访者中，II期胃癌（42.9%）是最可接受的适应症，但日本外科医生在这个问题上更为谨慎（P = 0.005）。与其他国家的外科医生相比，日本外科医生更常使用可弯曲内镜（P = 0.003）。中国和韩国比日本更常使用鹅颈弯曲抓钳（P = 0.006）。中国外科医生更喜欢剑突下垂直小切口剖腹术而非脐上垂直剖腹术。LTG最常采用体内重建（73.0%）。直线缝合器（53.8%）和圆形缝合器（42.1%）在食管空肠吻合术中都很常用。然而，空肠吻合术更多在体外进行（67.7%），这种情况下通常选择直线缝合器（86.4%）。在十二指肠残端加固（P = 0.018）和闭合彼得森间隙（P < 0.001）方面，三国之间存在显著差异。
这项涉及中国、韩国和日本外科医生的LTG调查清楚地反映了这种手术方式的当前实践情况，可能有助于未来的研究以及胃癌的临床治疗。
