Yin Jiu-Heng, Chen Yi-Hui, Ren Yan-Bei, Wang Rong, Su Shuai, Jiang En-Lai, Li Yun-Bo, Wang Ting, Xiao Wei-Dong, Du Guang-Sheng
Department of General Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China.
Nursing Department, Nursing School of Chongqing Medical and Pharmaceutical College, Chongqing, China.
Front Surg. 2023 Jan 9;9:1071363. doi: 10.3389/fsurg.2022.1071363. eCollection 2022.
This study aimed to explore the feasibility and safety of single-incision plus one-port laparoscopic total gastrectomy (SITG + 1) with Overlap esophagojejunostomy (SITG + 1-Overlap) and to share preliminary experiences.
This retrospective study included 10 patients with gastric cancer located in the cardia or body who underwent SITG + 1-Overlap between August 2020 and October 2021.The demographics, tumor characteristics, postoperative outcomes, and short-term complications of all the enrolled patients were summarized and statistically analyzed. Data were expressed as mean ± standard deviation (SD) if they were normally distributed. Otherwise, Median (Quartile1, Quartile3) was used.
In the collective perioperative data of these 10 patients who underwent radical gastrectomy, the median of the length of transumbilical incision and blood loss were 3.0 cm and 100.0 ml respectively, and the mean operation time and 385.5 ± 51.6 min. Postoperative data indicated that the gastric tube was removed on 2.0 (2.0, 3.0) days, and the timing of first feeding, activity, flatus, and defecation was 1.5 (1.0, 2.0) days, 2.0 (2.0, 2.0) days, 3.0 (2.0, 3.0) days, and 3.8 ± 0.6 days, respectively. The timing of drainage tube removal was 4.6 ± 1.0 days after operation. The duration of hospital stay was 7.5 ± 1.2 days and the VAS pain scores for the 3 days following surgery were 3.0 (2.0, 3.3), 2.0 (2.0, 3.0), and 1.5 (1.0, 2.0) respectively. The mean number of retrieved lymph nodes was 30.7 ± 13.2. Most biochemical indicators gradually normalized with the recovery of the patients after surgery. No 30-day postoperative complications were noted.
For the first time, our preliminary data indicate the feasibility and safety of Overlap esophagojejunostomy in SITG + 1 surgery. This modified Overlap procedure has the potential to simplify the reconstruction procedure and lower the technical challenge of SITG + 1 radical gastrectomy for cardia or upper gastric cancer in the early and advanced stages.
本研究旨在探讨单孔加单通道腹腔镜全胃切除术（SITG + 1）联合重叠式食管空肠吻合术（SITG + 1-Overlap）的可行性和安全性，并分享初步经验。
本回顾性研究纳入了2020年8月至2021年10月期间接受SITG + 1-Overlap手术的10例贲门或胃体部胃癌患者。总结并统计分析了所有入组患者的人口统计学资料、肿瘤特征、术后结局和短期并发症。数据若呈正态分布，则以均数±标准差（SD）表示。否则，采用中位数（四分位数1，四分位数3）表示。
在这10例行根治性胃切除术患者的围手术期总体数据中，脐部切口长度中位数和出血量分别为3.0 cm和100.0 ml，平均手术时间为385.5±51.6分钟。术后数据显示，胃管于术后2.0（2.0，3.0）天拔除，首次进食、活动、排气和排便时间分别为1.5（1.0，2.0）天、2.0（2.0，2.0）天、3.0（2.0，3.0）天和3.8±0.6天。引流管拔除时间为术后4.6±1.0天。住院时间为7.5±1.2天，术后3天的视觉模拟评分（VAS）疼痛评分分别为3.0（（2.0，3.3）、2.0（2.0，3.0）和1.5（1.0，2.0）。平均清扫淋巴结数为30.7±13.2枚。术后随着患者恢复，大多数生化指标逐渐恢复正常。术后30天未出现并发症。
我们的初步数据首次表明重叠式食管空肠吻合术在SITG + 1手术中的可行性和安全性。这种改良的重叠式手术有可能简化重建过程，降低SITG + 1根治性胃切除术治疗早期和进展期贲门或胃上部癌的技术难度。
