Proximal gastrectomy and digestive tract reconstruction: status survey of perceptions and treatment selection in Chinese surgeons
10.3760/cma.j.cn.441530-20191226-00526
- VernacularTitle:中国外科医生对近端胃切除及消化道重建的认知和治疗选择现况调查
- Author:
Zhiguo LI
1
;
Jianhong DONG
;
Qingxing HUANG
;
Kai TAO
;
Jun MA
;
Wanhong ZHANG
Author Information
1. 山西省肿瘤医院消化微创外科中心，太原 030013
- Keywords:
Proximal gastrectomy;
Digestive tract reconstruction;
Perception;
Treatment selection;
Questionnaire survey
- From:
Chinese Journal of Gastrointestinal Surgery
2020;23(8):757-765
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To understand the perceptions, attitudes and treatment selection of Chinese surgeons for proximal gastrectomy (PG) and digestive tract reconstruction.Methods:A cross-sectional survey was used in this study. Selection of subjects: (1) Domestic public grade IIIA (provincial and prefecture-level) tumor hospitals or general hospitals possessing the diagnosis and treatment qualifications for gastric cancer.(2) Surgeons with senior attending physician, associate chief physician and chief physician. The "Questionnaire Star" platform was used to design a questionnaire about cognition, attitude and treatment choice of "proximal gastrectomy and digestive tract reconstruction". The questionnaire contained 32 questions, such as the basic information of surgeons, the current status of gastric cancer surgery, the selection and management of surgical methods and related details for proximal gastric cancer, the choice of proximal gastrectomy and reconstruction of digestive tract, the related complications and nutritional status monitoring after proximal gastrectomy. A total of 76 questionnaires were linked to the respondents via WeChat between July 29 and August 25, 2019. Statistical analysis was performed using Chi-square test or Kruskal-Wallis test for categorical variables.Results:A total of 47 grade IIIA hospitals were included, and 76 questionnaires were sent out. The proportions of recovered and valid questionnaires were both 100%. For early and middle stage adenocarcinoma of esophagogastric junction (AEG), especially those smaller than 4 cm, 72.37% (55/76) of surgeons preferred proximal gastrectomy, while 22.37% (17/76) of surgeons chose total gastrectomy. For early AEG, 90.79% (69/76) of surgeons thought that endoscopic submucosal dissection (ESD) or proximal gastrectomy could be considered. For AEG below T3 stage and shorter than 4 cm, 60.53% (46/76) of surgeons gave priority to proximal gastrectomy, and 60.53% (46/76) of the surgeons believed that the advanced AEG with a higher radical cure should be treated with proximal gastrectomy, and the residual stomach should not be less than half stomach. Considering anti-reflux effect, postoperative weight recovery, clinical efficacy, wide application and easy popularization, surgeons preferred double-tract reconstruction. The surgeons in tumor hospitals had a higher approval rate for the application of proximal gastrectomy and the fact that the Kamikawa anastomosis was the most difficult to promote than the surgeons in provincial/municipal general hospitals. The surgeons with an annual surgical volume of more than 200 were more likely to choose proximal gastrectomy for early and middle stage AEG patients and the proportion was as high as 8/9. From the perspective of good clinical results, wide range of application, and easy popularization, the surgeons with a higher ratio (60.00%, 15/25) of double-tract reconstruction were those surgeons with 50-100 operations per year.Conclusions:The general level of cognition and acceptability of Chinese surgeons for proximal gastrectomy and reconstruction of digestive tract is suboptimal. In the future, it is urgent to promote the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy" so as to guide and optimize treatment in proximal gastric cancer.
