A multicenter retrospective study on the efficacy of different anti-reflux reconstruction methods after proximal gastrectomy for gastric cancer.
10.3760/cma.j.cn112139-20220418-00175
- Author:
Li YANG
1
;
Jian Zhang WU
2
;
Jun YOU
3
;
Lian FAN
4
;
Chang Qing JING
5
;
Quan WANG
6
;
Su YAN
7
;
Jiang YU
8
;
Lu ZANG
9
;
Jia Di XING
10
;
Wen Qing HU
11
;
Fenglin LIU
2
Author Information
1. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
2. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
3. Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital, Xiamen University, Xiamen 361000, China.
4. Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
5. Department of General Surgery, Shandong Provincial Hospital, Jinan 250021, China.
6. Department of General Surgery, the First Affiliated Hospital of Jilin University, Changchun 130061, China.
7. Department of Gastrointestinal Oncology Surgery, the Affiliated Hospital of Qinghai University, Xining 810001, China.
8. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
9. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
10. Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100143, China.
11. Department of General Surgery, Changzhi People's Hospital, Changzhi 046099, China.
- Publication Type:Multicenter Study
- MeSH:
Aged;
Albumins;
Esophagitis, Peptic/surgery*;
Female;
Gastrectomy/methods*;
Hemoglobins;
Humans;
Male;
Middle Aged;
Quality of Life;
Retrospective Studies;
Stomach Neoplasms/surgery*
- From:
Chinese Journal of Surgery
2022;60(9):838-845
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To examine the clinical efficacy of 3 anti-reflux methods of digestive tract reconstruction after proximal gastrectomy for gastric cancer. Methods: The clinical data and follow-up data of gastric cancer patients who underwent anti-reflux reconstruction after proximal gastrectomy in 11 medical centers of China from September 2016 to August 2021 were retrospectively collected, including 273 males and 65 females, aging of (63±10) years (range: 28 to 91 years). Among them, 159 cases were performed with gastric tube anastomosis (GTA), 107 cases with double tract reconstruction (DTR), and 72 cases with double-flap technique (DFT), respectively. The duration of operation, length of postoperative hospital stay and early postoperative complications (referring to Clavien-Dindo classification) of different anti-reflux reconstruction methods were assessed. Body mass index, hemoglobin and albumin were used to reflect postoperative nutritional status. Reflux esophagitis was graded according to Los Angeles criteria based on the routinely gastroscopy within 12 months after surgery. The postoperative quality of life (QoL) was evaluated by Visick score system. The ANOVA analysis, Kruskal-Wallis rank sum test, χ2 test and Fisher's exact test were used for comparison between multiple groups, and further comparison among groups were performed with LSD, Tamhane's test or Bonferroni corrected χ2 test. The mixed effect model was used to compare the trends of Body mass index, hemoglobin and albumin over time among different groups. Results: The operation time of DFT was significantly longer than that of GTA and DTR ((352±63) minutes vs. (221±66) minutes, (352±63) minutes vs. (234±61) minutes, both P<0.01). The incidence of early complications with Clavien-Dindo grade Ⅱ to Ⅴ in GTA, DFT and DTR groups was 17.0% (27/159), 9.7% (7/72) and 10.3% (11/107), respectively, without significant difference among these three groups (χ2=3.51, P=0.173). Body mass index decreased more significantly in GTA than DFT group at 6 and 12 months after surgery (mean difference=1.721 kg/m2, P<0.01; mean difference=2.429 kg/m2, P<0.01). body mass index decreased significantly in DTR compared with DFT at 12 months after surgery (mean difference=1.319 kg/m2, P=0.027). There was no significant difference in hemoglobin or albumin fluctuation between different reconstruction methods perioperative. The incidence of reflux esophagitis one year after surgery in DTR group was 12.9% (4/31), which was lower than that in DFT (45.9% (17/37), χ2=8.63, P=0.003). Follow-up of postoperative quality of life showed the incidence of Visick grade 2 to 4 in DFT group was lower than that in GTA group (10.4% (7/67) vs. 34.6% (27/78), χ2=11.70, P=0.018), while there was no significant difference between DFT and DTR group (10.4% (7/67) vs. 22.2% (8/36, P>0.05). Conclusions: Compared with GTA and DTR, DFT is more time-consuming, but there is no significant difference in early complications among three methods. DFT reconstruction is more conducive to maintain postoperative nutritional status and improve QoL, especially compared with GTA. The risk of reflux esophagitis after DTR reconstruction is lower than that of DFT.
