Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA (Dr. Schrope).
Department of Surgery, New York-Presbyterian Columbia University Medical Center, New York, New York, USA (Drs. Coons and Rosario).
JSLS. 2021 Jul-Sep;25(3). doi: 10.4293/JSLS.2021.00017.
Total gastrectomy with Roux-en-Y esophagojejunostomy is a life-extending procedure for patients with nonmetastatic proximal gastric and gastroesophageal junction adenocarcinoma, yet it can be a life-altering procedure with negative impact on quality of life. Perioperative recovery often involves the need for supplemental nutrition (either enteral or parenteral). Furthermore, long-term effects of early satiety, dysphagia, sustained weight loss, and difficulty in maintaining a healthy weight, dumping syndrome, and intestinal overgrowth are not unusual. Although the alternative of untreated cancer is clearly unacceptable, these lifestyle consequences are not benign.
A retrospective review of patients who had undergone laparoscopic total and proximal gastrectomy for gastric adenocarcinoma was conducted. Patient demographic data, pathologic parameters, and short-term and long-term clinical data were compared between total gastrectomy and proximal gastrectomy cohorts.
Seventeen patients were included in the study: 13 had undergone laparoscopic total gastrectomy (LTG) and 4 had undergone laparoscopic proximal gastrectomy (LPG). Patients who had LPG, given the nature of the procedure, were confined to early stage (up to T2) tumors in the gastric cardia or GE junction. Patients who had LTG tended to be larger, later stage tumors (but not exclusively). The mean operative time was greater for LTG than for LPG (247 ± 54 versus 181 ± 49 min, respectively, = .036). Length of hospital stay (9.0 ± 3.2 versus 5.0 ± 0.8 days, < .001) and readmission for postoperative complication (38.5 versus 0%, = .009) were also higher in the LTG group. There was no significant difference in terms of mean estimated blood loss or blood transfusion rates, overall complications, or anastomotic stricture requiring endoscopic dilation between the patients who underwent LTG and those who underwent LPG.
In early stage tumors (T1b or T2), proximal gastrectomy (PG) should be considered to mitigate diminished quality of life. PG with esophagogastrostomy, which can easily be performed minimally invasively, can be more tolerable for the patient, with no anatomic basis for dumping syndrome or small intestinal bacterial overgrowth (SIBO), and a greater reservoir for more normal meal habits when compared to total gastrectomy (TG) with Roux-en-Y reconstruction.
对于非转移性近端胃和胃食管交界处腺癌患者，全胃切除术加 Roux-en-Y 食管空肠吻合术是一种延长生命的手术方法，但它也可能是改变生活的手术，对生活质量产生负面影响。围手术期恢复通常需要补充营养（肠内或肠外）。此外，早饱、吞咽困难、持续体重减轻和维持健康体重困难、倾倒综合征和小肠过度生长等长期影响并不罕见。虽然未经治疗的癌症的选择显然是不可接受的，但这些生活方式的后果并非良性。
对接受腹腔镜全胃切除术和近端胃切除术治疗胃腺癌的患者进行了回顾性研究。比较了全胃切除术和近端胃切除术两组患者的人口统计学数据、病理参数以及短期和长期临床数据。
研究纳入 17 例患者：13 例行腹腔镜全胃切除术（LTG），4 例行腹腔镜近端胃切除术（LPG）。由于手术的性质，行 LPG 的患者仅限于贲门或胃食管交界处的早期（T2 期）肿瘤。行 LTG 的患者往往更大，肿瘤分期更晚（但并非排他性）。LTG 的手术时间长于 LPG（分别为 247±54 分钟和 181±49 分钟， = .036）。LTG 组的住院时间（9.0±3.2 天与 5.0±0.8 天， < .001）和术后并发症再入院率（38.5%与 0%， = .009）也较高。LTG 组和 LPG 组在平均估计出血量或输血率、总并发症或需要内镜扩张的吻合口狭窄方面无显著差异。
在早期肿瘤（T1b 或 T2）中，应考虑近端胃切除术（PG）以减轻生活质量下降。PG 加食管胃吻合术，可通过微创轻松进行，对患者更具耐受性，由于没有倾倒综合征或小肠细菌过度生长（SIBO）的解剖基础，以及与 Roux-en-Y 重建的全胃切除术（TG）相比，有更大的储留容量，更有利于正常的饮食习惯。
