Yu Jing, Li Min, Qin Xiang-Zhi, Gong Lei, Qin Long, Lv Zhen-Bing, Guo Wei, Huang Bin, Tian Yun-Hong
Department of Gastrointestinal Surgery, The Affiliated Nanchong Central Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China.
Department of Gastrointestinal Surgery, Beijing Anzhen Nanchong Hospital of Capital Medical University and Nanchong Central Hospital, Nanchong 637000, Sichuan Province, China.
World J Gastrointest Surg. 2025 Jun 27;17(6):106009. doi: 10.4240/wjgs.v17.i6.106009.
At present, the concept of surgical treatment of gastric cancer (GC) has changed from "radical treatment" to "care for patients" to a certain extent. The reconstruction method is the most likely to affect the postoperative life of the patient. Currently, the traditional Roux-en-Y esophagojejunostomy anastomosis is a commonly used method for gastrointestinal reconstruction after total gastrectomy for GC. However, more recent studies have shown that the traditional Roux-en-Y anastomosis is complicated in operation procedure, with more reconstruction steps and longer reconstruction time, and the incidence of postoperative complications such as adhesive intestinal obstruction, internal abdominal hernia and volvulus is high. Moreover, the incidence of Roux stasis syndrome is 10%-30% after traditional Roux-en-Y reconstruction. Thus, we modified the traditional Roux-en-Y alimentary tract reconstruction, and designed a new digestive tract reconstruction method for laparoscopy-assisted Roux-en-Y anastomosis for total gastrectomy of GC.
To evaluate the clinical advantages, feasibility, and safety of a modified Roux-en-Y digestive tract reconstruction in laparoscopy-assisted total gastrectomy for the treatment of GC compared with the traditional Roux-en-Y method.
Ninety-seven patients who underwent laparoscopy-assisted D2 radical gastrectomy (total gastrectomy) for GC were divided into two groups: fifty-four in the conventional Roux-en-Y reconstruction group (Orr group) and forty-three in the modified Roux-en-Y reconstruction group (the modified group). Perioperative and short-term outcomes were analyzed, including complications, postoperative weight loss, hemoglobin levels, and nutritional status.
The Orr group and the modified group showed no statistically significant differences in baseline characteristics. Compared with the Orr group, the modified group had shorter digestive tract reconstruction and operation times, less intraoperative bleeding, and shorter postoperative hospital stays compared to the Orr group. Although both groups had similar amounts of intraoperative blood loss, postoperative recovery times, and hospital expenses, the Orr group experienced longer operation times and digestive tract reconstruction times. Furthermore, the modified Roux-en-Y group demonstrated significantly fewer short-term and long-term complications, with a reduced incidence of reflux esophagitis and improved nutritional status.
The modified Roux-en-Y digestive tract reconstruction method after laparoscopy-assisted total gastrectomy for GC offers safety, simplicity, and a reduction in bile reflux. This method shortens operation times and minimizes postoperative complications, aligns with modern rapid rehabilitation surgery trends and potentially improves patient prognosis and overall survival. This method warrants further clinical application and promotion.
目前，胃癌（GC）外科治疗理念在一定程度上已从“根治性治疗”转变为“以患者为中心”。重建方式最有可能影响患者术后生活。目前，传统的Roux-en-Y食管空肠吻合术是GC全胃切除术后常用的胃肠道重建方法。然而，最近的研究表明，传统的Roux-en-Y吻合术手术操作复杂，重建步骤多，重建时间长，术后粘连性肠梗阻、腹内疝和肠扭转等并发症发生率高。此外，传统Roux-en-Y重建术后Roux滞留综合征的发生率为10%-30%。因此，我们对传统的Roux-en-Y消化道重建进行了改良，设计了一种用于GC全胃切除的腹腔镜辅助Roux-en-Y吻合术的新型消化道重建方法。
评估改良的Roux-en-Y消化道重建在腹腔镜辅助全胃切除治疗GC中相对于传统Roux-en-Y方法的临床优势、可行性和安全性。
97例行腹腔镜辅助D2根治性胃切除术（全胃切除术）治疗GC的患者分为两组：传统Roux-en-Y重建组（Orr组）54例，改良Roux-en-Y重建组（改良组）43例。分析围手术期和短期结局，包括并发症、术后体重减轻、血红蛋白水平和营养状况。
Orr组和改良组在基线特征方面无统计学显著差异。与Orr组相比，改良组消化道重建和手术时间更短，术中出血量更少，术后住院时间更短。尽管两组术中出血量、术后恢复时间和住院费用相似，但Orr组手术时间和消化道重建时间更长。此外，改良Roux-en-Y组的短期和长期并发症明显更少，反流性食管炎发生率降低，营养状况改善。
GC腹腔镜辅助全胃切除术后改良的Roux-en-Y消化道重建方法具有安全性、简便性，可减少胆汁反流。该方法缩短了手术时间，将术后并发症降至最低，符合现代快速康复外科趋势，可能改善患者预后和总体生存。该方法值得进一步临床应用和推广。
