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Impact of Esophagojejunal Reconstruction without Division of the Mesentery for Total Laparoscopic Total Gastrectomy

Journal of Gastric Cancer 2021년 21권 1호 p.63 ~ 73
고창석, 정진호, 이인섭, 김범수, 김민주, 유문원,
소속 상세정보
고창석 ( Ko Chang-Seok ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
정진호 ( Jheong Jin-Ho ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
이인섭 ( Lee In-Seob ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김범수 ( Kim Beom-Su ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
김민주 ( Kim Min-Ju ) - University of Ulsan College of Medicine Asan Medical Center Department of Clinical Epidemiology and Biostatistics
유문원 ( Yoo Moon-Won ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery

Abstract


Purpose: This study aimed to compare the surgical outcomes of total laparoscopic total gastrectomy without mesentery division (LTG without MD) and conventional total laparoscopic total gastrectomy (CLTG), as well as evaluate the appropriate method for esophagojejunostomy (EJ) reconstruction after total laparoscopic total gastrectomy (TLTG).

Materials and Methods: We retrospectively analyzed data from 301 consecutive patients who underwent TLTG for upper or middle third gastric cancer between January 2016 and May 2019. After propensity score matching, 95 patients who underwent LTG without MD and 95 who underwent CLTG were assessed. Data on clinical characteristics and surgical outcomes, including operation time, length of postoperative hospital stay, pathological findings, and postoperative complications were analyzed.

Results: The LTG without MD group showed a shorter time to first flatus (3.26±0.80 vs. 3.62±0.81 days, P=0.003) and a shorter time to soft diet (2.80±2.09 vs. 3.52±2.20 days, P=0.002). The total EJ-related complications in the LTG without MD group were comparable to those in the CLTG group (9.47% vs. 3.16%, P=0.083). EJ-related leakage (6.32% vs. 3.16%, P=0.317) and EJ-related stricture (3.16% vs. 1.05%, P=0.317) rates were not significantly different between the LTG without MD and CLTG groups. No significant differences were found between the two groups in terms of other early surgical outcomes such as early complications, late complications, hospital stay, and readmission rate.

Conclusions: LTG without MD is a safe surgical treatment for upper or middle third gastric cancer. LTG without MD may be an alternative procedure for EJ anastomosis during TLTG.

키워드

Laparoscopic surgery; Gastrectomy; Stomach neoplasms; Anastomosis

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