Wu Zhen, Zhou Zhi-Gang, Li Ling-Yu, Gao Wen-Jing, Yu Ting
Department of General Surgery, Yixing Traditional Chinese Medicine Hospital, Wuxi 214200, Jiangsu Province, China.
World J Gastrointest Surg. 2023 Jul 27;15(7):1354-1362. doi: 10.4240/wjgs.v15.i7.1354.
Gastric cancer is the most common cause of cancer-related deaths, and is classified according to its location in the proximal, middle, or distal stomach. Surgical resection is the primary approach for treating gastric cancer. This prospective study aimed to determine the best reconstruction method after distal gastrectomy for gastric cancer.
To explore the efficacy of different staplers and digestive tract reconstruction (DTR) methods after radical gastrectomy and their influence on prognosis.
Eighty-seven patients who underwent radical gastrectomy for distal gastric cancer at our institution between April 2017 and April 2020 were included in this study, with a follow-up period of 12-26 mo. The patients were assigned to four groups based on the stapler and DTR plan as follows: Billroth Ⅰ (B-I) reconstruction + linear stapler group (group A, 22 cases), B-I reconstruction + circular stapler group (group B, 22 cases), Billroth II (B-II) reconstruction + linear stapler group (group C, 22 cases), and B-II reconstruction + circular stapler group (group D, 21 cases). The pathological parameters, postoperative gastrointestinal function recovery, postoperative complications, and quality of life (QOL) were compared among the four groups.
No significant differences in the maximum diameter of the gastric tumors, total number of lymph nodes dissected, drainage tube removal time, QLQ (QOL questionnaire)-C30 and QLQ-STO22 scores at 1 year postoperatively, and incidence of complications were observed among the four groups ( > 0.05). However, groups A and C (linear stapler) had significantly lower intraoperative blood loss and significantly shorter anastomosis time, operation time, first fluid diet intake time, first exhaust time, and length of postoperative hospital stay ( < 0.05) than groups B and D (circular stapler).
Linear staplers offer several advantages for postoperative recovery. B-I and B-II reconstruction methods had similar effects on QOL. The optimal solution can be selected according to individual conditions and postoperative convenience.
胃癌是癌症相关死亡的最常见原因，根据其在胃近端、中端或远端的位置进行分类。手术切除是治疗胃癌的主要方法。这项前瞻性研究旨在确定远端胃癌切除术后的最佳重建方法。
探讨根治性胃切除术后不同吻合器及消化道重建（DTR）方法的疗效及其对预后的影响。
本研究纳入了2017年4月至2020年4月在我院接受远端胃癌根治性切除术的87例患者，随访时间为12 - 26个月。根据吻合器和DTR方案将患者分为四组，如下：毕Ⅰ式（B - I）重建 + 直线切割吻合器组（A组，22例），B - I重建 + 圆形吻合器组（B组，22例），毕Ⅱ式（B - II）重建 + 直线切割吻合器组（C组，22例），以及B - II重建 + 圆形吻合器组（D组，21例）。比较四组的病理参数、术后胃肠功能恢复情况、术后并发症及生活质量（QOL）。
四组在胃肿瘤最大直径、清扫淋巴结总数、引流管拔除时间、术后1年的QLQ（QOL问卷）- C30和QLQ - STO22评分以及并发症发生率方面均无显著差异（> 0.05）。然而，A组和C组（直线切割吻合器）的术中出血量明显低于B组和D组（圆形吻合器），吻合时间、手术时间、首次流食摄入时间、首次排气时间及术后住院时间也明显短于B组和D组（< 0.05）。
直线切割吻合器在术后恢复方面具有诸多优势。B - I和B - II重建方法对生活质量的影响相似。可根据个体情况和术后便利性选择最佳方案。
