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2024 ; 16
(7
): 2012-2022
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Clinical efficacy and safety of double-channel anastomosis and tubular
gastroesophageal anastomosis in gastrectomy
#MMPMID39087109
Liu BY
; Wu S
; Xu Y
World J Gastrointest Surg
2024[Jul]; 16
(7
): 2012-2022
PMID39087109
show ga
BACKGROUND: With the continuous progress of surgical technology and improvements
in medical standards, the treatment of gastric cancer surgery is also evolving.
Proximal gastrectomy is a common treatment, but double-channel anastomosis and
tubular gastroesophageal anastomosis have attracted much attention in terms of
surgical options. Each of these two surgical methods has advantages and
disadvantages, so it is particularly important to compare and analyze their
clinical efficacy and safety. AIM: To compare the surgical safety, clinical
efficacy, and safety of double-channel anastomosis and tubular gastroesophageal
anastomosis in proximal gastrectomy. METHODS: The clinical and follow-up data of
99 patients with proximal gastric cancer who underwent proximal gastrectomy and
were admitted to our hospital between January 2018 and September 2023 were
included in this retrospective cohort study. According to the different
anastomosis methods used, the patients were divided into a double-channel
anastomosis group (50 patients) and a tubular gastroesophageal anastomosis group
(49 patients). In the double-channel anastomosis, Roux-en-Y anastomosis of the
esophagus and jejunum was performed after proximal gastric dissection, and then
side-to-side anastomosis was performed between the residual stomach and jejunum
to establish an antireflux barrier and reduce postoperative gastroesophageal
reflux. In the tubular gastroesophageal anastomosis group, after the proximal end
of the stomach was cut, tubular gastroplasty was performed on the distal stump of
the stomach and a linear stapler was used to anastomose the posterior wall of the
esophagus and the anterior wall of the stomach tube. The main outcome measure was
quality of life 1 year after surgery in both groups, and the evaluation criteria
were based on the postgastrectomy syndrome assessment scale. The greater the
changes in body mass, food intake per meal, meal quality subscale score, and
total measures of physical and mental health score, the better the condition; the
greater the other indicators, the worse the condition. The secondary outcome
measures were intraoperative and postoperative conditions, the incidence of
postoperative long-term complications, and changes in nutritional status at 1, 3,
6, and 12 months after surgery. RESULTS: In the double-channel anastomosis
cohort, there were 35 males (70%) and 15 females (30%), 33 (66.0%) were under 65
years of age, and 37 (74.0%) had a body mass index ranging from 18 to 25 kg/m(2).
In the group undergoing tubular gastroesophageal anastomosis, there were eight
females (16.3%), 21 (42.9%) individuals were under the age of 65 years, and 34
(69.4%) had a body mass index ranging from 18 to 25 kg/m(2). The baseline data
did not significantly differ between the two groups (P > 0.05 for all), with the
exception of age (P = 0.021). The duration of hospitalization, number of lymph
nodes dissected, intraoperative blood loss, and perioperative complication rate
did not differ significantly between the two groups (P > 0.05 for all). Patients
in the dual-channel anastomosis group scored better on quality of life measures
than did those in the tubular gastroesophageal anastomosis group. Specifically,
they had lower scores for esophageal reflux [2.8 (2.3, 4.0) vs 4.8 (3.8, 5.0), Z
= 3.489, P < 0.001], eating discomfort [2.7 (1.7, 3.0) vs 3.3 (2.7, 4.0), Z =
3.393, P = 0.001], total symptoms [2.3 (1.7, 2.7) vs 2.5 (2.2, 2.9), Z = 2.243, P
= 0.025], and other aspects of quality of life. The postoperative symptoms [2.0
(1.0, 3.0) vs 2.0 (2.0, 3.0), Z = 2.127, P = 0.033], meals [2.0 (1.0, 2.0) vs 2.0
(2.0, 3.0), Z = 3.976, P < 0.001], work [1.0 (1.0, 2.0) vs 2.0 (1.0, 2.0), Z =
2.279, P = 0.023], and daily life [1.7 (1.3, 2.0) vs 2.0 (2.0, 2.3), Z = 3.950, P
< 0.001] were all better than those of the tubular gastroesophageal anastomosis
group. The group that underwent tubular gastroesophageal anastomosis had a
superior anal exhaust score [3.0 (2.0, 4.0) vs 3.5 (2.0, 5.0) (Z = 2.345, P =
0.019] compared to the dual-channel anastomosis group. Hemoglobin, serum albumin,
total serum protein, and the rate at which body mass decreased one year following
surgery did not differ significantly between the two groups (P > 0.05 for all).
CONCLUSION: The safety of double-channel anastomosis in proximal gastric cancer
surgery is equivalent to that of tubular gastric surgery. Compared with tubular
gastric surgery, double-channel anastomosis is a preferred surgical technique for
proximal gastric cancer. It offers advantages such as less esophageal reflux and
improved quality of life.