OBJECTIVETo explore the risk factors of delayed gastric emptying after gastrectomy.

METHODSMeta-analysis was performed to screen risk factors of delayed gastric emptying after gastrectomy based on 19 associated articles published from 2003 to 2013.

RESULTSGender, operative time, blood loss during operation, surgical settings(emergency, elective surgery), radical surgery were not significantly different between two groups for delayed gastric emptying (all P>0.05). Age more than or equal to 60 years [combined odds ratio(OR)=1.65, 95% confidence interval(CI):1.31-2.09, P<0.01], preoperative gastrointestinal obstruction(combined OR=3.72, 95%CI:3.05-4.55, P<0.01), Billroth-II( (combined OR=3.35, 95%CI:2.72-4.13, P<0.01), anemia(combined OR=1.48, 95%CI:1.08-2.02, P=0.01), intra-abdominal complication (combined OR=2.41, 95%CI:1.77-3.29, P<0.01), perioperative blood glucose greater than 8 mmol/L(combined OR=2.64, 95%CI:2.00-3.49, P<0.01), postoperative albumin levels lower than 30 g/L (combined OR=2.13, 95%CI:1.62-2.79, P<0.01), use of analgesics pump after operation (combined OR=1.74, 95%CI:1.33-2.26, P<0.01), having adverse psychological reactions (combined OR=5.94, 95%CI:1.79-19.73, P=0.004) were risk factors affecting delayed gastric emptying.

CONCLUSIONAge more than or equal to 60, preoperative gastrointestinal obstruction, perioperative blood glucose greater than or equal to 8 mmol/L, postoperative albumin levels less than 30 g/L, Billroth-II(, anemia, intra-abdominal complication, using pain pump after operation, having adverse psychological reactions are risk factors affecting delayed gastric emptying after gastrectomy.

Gastrectomy ; adverse effects ; Gastroenterostomy ; Gastroparesis ; etiology ; Humans ; Risk Factors

In recent years, laparoscopic gastrectomy has developed rapidly for both early and advanced gastric cancer. Most studies showed that the operative complication rate is comparable between laparoscopic and open surgery. The common complications related to laparoscopic gastrectomy are anastomotic leakage, stenosis, intra-abdominal bleeding, pancreatic leakage, bowel obstruction, etc. This article provides insights into the reasons, classification, management, and prevention of the complications related to laparoscopic gastrectomy.
Gastrectomy ; adverse effects ; methods ; Humans ; Laparoscopy ; adverse effects ; Postoperative Complications ; therapy ; Stomach Neoplasms ; surgery

Surgical resection plays pivotal role in the treatment of gastric cancer. Adequate preoperative evaluation, precise intraoperative maneuver and delicate postoperative management lay the foundation for successful gastrectomy. The aim of preoperative evaluation is to stage tumor and identify potential risk factors (including preoperative factors like age, ASA status, body mass index, comorbidity, hypoalbuminemia, and intraoperative factors like blood loss and combined resection) which could lead to postoperative complication. With the management of prehabilitation, adequate medical decision could be made and patient's fast recovery could be ensured. With the rapid adoption of ERAS concept, there is increasing attention to prehabilitation which focus on optimization of cardio-pulmonary capacity and muscular-skeletal capacity. Despite of the efficacy of prehabilitation demonstrated by randomized controlled trials, consensus has yet to be reached on the following items: specific intervention, optimal measurement, candidate population and optimal timing for intervention. Balancing the efficiency and safety, preoperative evaluation could be put into clinical practice smoothly.
Humans ; Stomach Neoplasms/complications* ; Preoperative Care/adverse effects* ; Postoperative Complications/etiology* ; Gastrectomy/adverse effects* ; Risk Factors

Background:Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG.

Methods:Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3.

Results:Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: -13.52 ml; 95% CI: -24.82--2.22; P = 0.02), earlier time to first oral intake (WMD: -0.49 day; 95% CI: -0.83--0.14; P < 0.01), and shorter length of hospitalization (WMD: -0.62 day; 95% CI: -1.08--0.16; P < 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P > 0.05).

ConclusionsCompared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.

Esophagostomy ; adverse effects ; methods ; Esophagus ; surgery ; Gastrectomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Laparoscopy ; adverse effects ; methods ; Stomach Neoplasms ; surgery ; Treatment Outcome

It is the most important for surgeons to achieve surgical safety and oncological clearance in laparoscopic surgery for gastric cancer. With the widespread adoption oflaparoscopic surgery for gastric cancer, surgeons make great efforts to achieve better safety andlower morbidity. Common abdominal complications (intraoperative and postoperative) after laparoscopic radical gastrectomy include bleeding, anastomotic leakage, anastomotic stenosis, iatrogenic organ injury, pancreatic leakage, etc. The causes and prevention of the complications related with laparoscopic radical gastrectomy was discussed in this article.
Anastomotic Leak ; Constriction, Pathologic ; Gastrectomy ; adverse effects ; Humans ; Laparoscopy ; adverse effects ; Postoperative Complications ; prevention & control ; Stomach Neoplasms ; surgery

Hilar splenic lymph node metastasis is one of the risk factors for poor prognosis in patients with proximal gastric cancer. Laparoscopic spleen-preserving splenic hilar lymph node dissection (LSPSHLD) can effectively improve the survival benefits of patients at high risk of splenic hilar lymph node metastasis. However, LSPSHLD is still a challenging surgical difficulty in radical resection of proximal gastric cancer. Moreover, improper operation can easily lead to splenic vascular injury, spleen injury and pancreatic injury and other related complications, due to the deep anatomical location of the splenic hilar region and the intricate blood vessels.Therefore, in the prevention and treatment of LSPSHLD-related complications, we should first focus on prevention, clarify the indication of surgery, and select the benefit group of LSPSHLD individually, so as to avoid the risk caused by over-dissection. Meanwhile, during the perioperative period of LSPSHLD, it is necessary to improve the cognition of related risk factors, conduct standardized and accurate operations in good surgical field exposure and correct anatomical level to avoid surrounding tissues and organs injury, and master the surgical skills and effective measures to deal with related complications, so as to improve the surgical safety of LSPSHLD.
Humans ; Spleen/surgery* ; Lymphatic Metastasis/pathology* ; Stomach Neoplasms/pathology* ; Gastrectomy/adverse effects* ; Lymph Node Excision/adverse effects* ; Lymph Nodes/pathology* ; Laparoscopy/adverse effects* ; Retrospective Studies

For the vast majority of morbidly obese patients, surgical treatment remains the only effective way proven to maintain weight loss. Currently adjustable gastric banding (AGB), sleeve gastrectomy (SG), Roux-en-Y gastric bypass(RYGB) are the methods which are recognized as safe, reliable, effective for weight loss, and has been widely used. Along with the increase in the volume of bariatric operations, patients whose primary bariatric operation is not ideal and who need revision surgery are also increasing. Weight loss failure and postoperative complications are two of the main indications for revisional operation. A series of data indicate that revisional operation is an effective treatment for unsuccessful weight loss and complications of primary operation. Surgeons should choose reasonable, correct operation refer to the initial bariatric operation and results. For most patients, the benefits overweigh the risks.
Bariatric Surgery ; adverse effects ; Gastrectomy ; Gastric Bypass ; Humans ; Postoperative Complications ; etiology ; Treatment Outcome ; Weight Loss

Adult ; Chylous Ascites ; etiology ; Female ; Gastrectomy ; adverse effects ; Humans ; Stomach Neoplasms ; surgery

Gastric cancer is one of the most common gastrointestinal malignancies in China. D2 radical gastrectomy is the main treatment for advanced gastric cancer patients. With the advancement of laparoscopic technology, laparoscopic radical gastrectomy has been gradually developed in the world, and even popularized in China. There have been a lot of literature reports on the indications, the scope of lymph node dissection and the improvement of techniques of laparoscopic radical gastrectomy for gastric cancer. Relevant guidelines or consensus for radical gastrectomy. The prevention and treatment of complications of gastrointestinal reconstruction for laparoscopic radical gastric cancer surgery is a major concern for gastrointestinal surgeons. Once complications occur in digestive tract reconstruction, it would increase the hospitalization cost, prolong the hospitalization stay of patients, delay follow-up chemotherapy, and even lead to postoperative death or other serious consequences. Therefore, it is of positive and far-reaching clinical significance to pay attention to the techniques of gastrointestinal reconstruction after laparoscopic radical gastric cancer surgery, to reduce the occurrence of gastrointestinal reconstruction complications, and to detect and reasonably manage related complications in a timely manner. The Chinese expert consensus on prevention and treatment of complications related to digestive tract reconstruction after laparoscopic radical gastrectomy for gastric cancer (2022 edition) has significance value for reducing the occurrence of gastrointestinal reconstruction complications. This manuscript mainly serves as the interpretation and supplement of this Consensus.
Humans ; Consensus ; Gastrectomy/methods* ; Laparoscopy/adverse effects* ; Lymph Node Excision ; Retrospective Studies ; Stomach Neoplasms/pathology* ; China

Radical gastrectomy for gastric cancer results in various post-operative complications, and the influencing factors are complicated. The diagnosis, treatment and prevention of common complications have been reported in many literatures. However, there are few reports on the prevention and treatment of rare complications. Rare complications after radical gastrectomy are often overlooked due to their low incidence. In addition, there are few guidelines and expert consensus regarding to the rare complications. Therefore, clinicians may lack experience in the diagnosis, treatment and prevention of rare complications after radical gastrectomy. Based on the literature review and the author's experience, this article systematically reviews seven rare complications after radical gastrectomy (duodenal stump fistula, pancreatic fistula, chyle leakage, esophagomediastinal fistula, internal hernia, gastroparesis, and intussusception). This article aims to provide a comprehensive reference for the diagnosis, treatment and prevention of rare complications after radical gastrectomy for gastric cancer patients.
Humans ; Stomach Neoplasms/complications* ; Gastrectomy/methods* ; Postoperative Complications/etiology* ; Duodenal Diseases ; Laparoscopy/adverse effects* ; Retrospective Studies