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| 1 | Comparision of modified and conventional delta-shaped gastroduodenostomy in totally laparoscopic surgery显示文摘AIM:To evaluate the safety and feasibility of a modified delta-shaped gastroduodenostomy(DSG)in totally laparoscopic distal gastrectomy(TLDG).METHODS:We performed a case-control study enrolling 63 patients with distal gastric cancer(GC)undergoing TLDG with a DSG from January 2013 to June 2013.Twenty-two patients underwent a conventional DSG(Con-Group),whereas the other 41 patients underwent a modified version of the DSG(Mod-Group).The modified procedure required only the instruments of the surgeon and assistant to complete the involution of the common stab incision and to completely resect the duodenal cutting edge,resulting in an anastomosis with an inverted T-shaped appearance.The clinicopathological characteristics,surgical outcomes,anastomosis time and complications of the two groups were retrospectively analyzed using a prospectively maintained comprehensive database.RESULTS:DSG procedures were successfully completed in all of the patients with histologically complete(R0)resections,and none of these patients required conversion to open surgery.The clinicopathological characteristics of the two groups were similar.There were no significant differences between the groups in the operative time,intraoperative blood loss,extension of the lymph node(LN)dissection and number of dissected LNs(150.8±21.6 min vs 143.4±23.4 min,P=0.225for the operative time;26.8±11.3 min vs 30.6±14.8mL,P=0.157 for the intraoperative blood loss;4/18 vs3/38,P=0.375 for the extension of the LN dissection;and 43.9±13.4 vs 39.5±11.5 per case,P=0.151 for the number of dissected LNs).The anastomosis time,however,was significantly shorter in the Mod-Group than in the Con-Group(13.9±2.8 min vs 23.9±5.6min,P=0.000).The postoperative outcomes,including the times to out-of-bed activities,first flatus,resumption of soft diet and postoperative hospital stay,as well as the anastomosis size,did not differ significantly(1.9±0.6 d vs 2.3±1.5 d,P=0.228 for the time to outof-bed activities;3.2±0.9 d vs 3.5±1.3 d,P=0.295for the first flatus time;7.5±0.8 d vs 8.1±4.3 d,P=0.489 for the resumption of a soft diet time;14.3±10.6 d vs 11.5±4.9 d,P=0.148 for the postoperative hospital stay;and 30.5±3.6 mm vs 30.1±4.0 mm,P=0.730 for the anastomosis size).One patient with minor anastomotic leakage in the Con-Group was managed conservatively;no other patients experienced any complications around the anastomosis.The operative complication rates were similar in the Con-and ModGroups(9.1%vs 7.3%,P=1.000).CONCLUSION:The modified DSG,an alternative reconstruction in TLDG for GC,is technically safe and feasible,with a simpler process that reduces the anastomosis time. | Chang-Ming Huang Mi Lin Jian-Xian Lin Chao-Hui Zheng Ping Li Jian-Wei Xie Jia-Bin Wang Jun Lu | 2014 | World Journal of Gastroenterology2014，20，30： | 26 |
| 2 | Laparoscopic and robot-assisted gastrectomy for gastric cancer: Current considerations显示文摘Radical gastrectomy with an adequate lymph-adenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer(GC). A number of randomized controlled trials and meta-analysis provide phase Ⅲ evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomyfor cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival. | Stefano Caruso Alberto Patriti Franco Roviello Lorenzo De Franco Franco Franceschini Andrea Coratti Graziano Ceccarelli | 2016 | World Journal of Gastroenterology2016，22，25： | 23 |
| 3 | Histological mixed-type as an independent prognostic factor in stageⅠgastric carcinoma显示文摘AIM: To evaluate the clinicopathological features of mixed-type gastric cancer and their influence on prognosis of mixed-type stageⅠgastric cancer.METHODS: We analyzed 446 patients who underwent curative gastrectomy for stageⅠgastric cancer between 1999 and 2009. The patients were divided into two groups: those with differentiated or undifferentiated cancer(non-mixed-type, n = 333) and those with a mixture of differentiated and undifferentiated cancers(mixed-type, n = 113).RESULTS: The overall prevalence of mixed-type gastric cancer was 25.3%(113/446). Compared with patients with non-mixed-type gastric cancer, those with mixedtype gastric cancer tended to be older at onset(P = 0.1252) and have a higher incidence of lymph node metastasis(P = 0.1476). They also had significantly larger tumors(P < 0.0001), more aggressive lymphatic invasion(P = 0.0011), and deeper tumor invasion(P < 0.0001). In addition, they exhibited significantly worse overall survival rates than did patients with non-mixedtype gastric cancer(P = 0.0026). Furthermore, mixedtype gastric cancer was independently associated with a worse outcome in multivariate analysis [P = 0.0300, hazard ratio = 11.4(1.265-102.7)].CONCLUSION: Histological mixed-type of gastric cancer contributes to malignant outcomes and highlight its usefulness as a prognostic indicator in stageⅠgastric cancer. | Shuhei Komatsu Daisuke Ichikawa Mahito Miyamae Hiroki Shimizu Hirotaka Konishi Atsushi Shiozaki Hitoshi Fujiwara Kazuma Okamoto Mitsuo Kishimoto Eigo Otsuji | 2015 | World Journal of Gastroenterology2015，21，2： | 6 |
| 4 | SiewertⅡ型和Ⅲ型食管胃结合部腺癌腹腔镜辅助与开腹全胃切除的疗效比较显示文摘目的对比研究腹腔镜辅助全胃切除术(LATG)和开腹全胃切除术(OTG)治疗SiewertⅡ型和Ⅲ型食管胃结合部腺癌(AEG)的临床疗效。方法回顾性分析2009年8月至2014年2月徐州医学院附属淮安医院普外科收治的75例行全胃切除的SiewertⅡ型和Ⅲ型AEG患者的临床资料,其中LATG组32例,OTG组43例。分析比较两组患者临床病理特征、术中情况、根治效果与肿瘤复发情况等指标。患者采用电话或者门诊复查方式进行随访。随访时间截至2015年8月。结果两组手术均顺利完成,无围手术期死亡。LATG组患者平均手术时间为(3.23±0.35)h,长于OTG组的(2.83±0.51)h,平均术中出血(122.7±50.6)ml,少于OTG组的(219.2±85.2)ml,术后人均镇痛次数(3.00±0.67)次,少于OTG组的(3.43±1.03)次,胃肠功能恢复时间(2.69±0.46)d,短于OTG组的(3.42±0.86)d,术后平均住院时间(12.94±2.76)d,少于OTG组的(14.57±2.35)d(P均<0.05)。两组患者清扫淋巴结数目、近端切缘、远端切缘、术后并发症发生率和术后6个月血清CEA水平的比较,差异无统计学意义(P>0.05)。结论 LATG在治疗SiewertⅡ型和Ⅲ型AEG患者的根治效果和肿瘤复发方面与开腹手术相当,但术中出血少、术后疼痛少、胃肠功能恢复快、住院时间短,值得推广。 | 张晓雨 平洪 杨金云 陈一尘 | 2016 | 中华临床医师杂志(电子版)2016，10，15： | 6 |
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