A Clinical Research On Application Of The Delta-shaped Anastomosis In Totally Laparoscopic Distal Gastrectomy Of Gastric Cancer For Digestive Reconstruction

Objective:Investigating the feasibility and significance of the delta-shaped anastomosis in totally laparoscopic distal gastrectomy of gastric cancer for Billroth I digestive reconstruction.Methods:We retrospectively analyzed50successive gastric cancer patients who underwent the delta-shaped anastomosis between June and November in2014. All patients had operations of the totally laparoscopic distal gastrectomy with D2lymph node dissection by a single surgeon. The major data include the patients’characteristic, operative time, blood loss, total retrieved lymph nodes, resection margins, first flatus, first liquid diet, postoperative hospital stay, postoperative complications and postoperative follow-up situation. Since the surgical procedures were different, the254gastric cancer patients who underwent distal gastrectomy performed by a single surgeon between January2011and February2015were divided into3groups:ODG, LADG and TLDG According to the same inclusion criteria,30patients were selected from each group, and then the patients’surgical outcomes, immunologic changes, the degree of dissection of tumor and the cost were compared. Results:No one was converted into open surgery in these50patients. The mean operation time was (217.4±45.89) min, the mean time of delta-shaped anastomosis (15.0±3.9) min, the mean blood loss (95.0±60.06) ml, the resection margins (4.60±0.57/3.37±0.45) cm respectively, the total retrieved lymph nodes (35.55±11.53), the first flatus time (3.7±0.34) days, the first liquid diet time (4.5±0.50)days and the postoperative hospital stay (7.85±1.3) days. There were no major complications, such as anastomotic bleeding, anastomotic leakage, anastomotic stenosis, abdominal abscess and pulmonary infection. Nobody was reported death, cancer recurrences and anastomotic stenosis in the follow-up. There were no significant difference in these three groups in respect to sex, age, general conditions, BMI index, ASA status and TNM stage. The TLDG group was significantly better than the LADG group and ODG group in blood loss, dosage of additional analgesics use, first flatus, first liquid diet time and postoperative hospital stay, and there was significant difference among these three groups(P<0.05). At the first postoperative day, the amount of white blood cells and the level of C-reactive protein in serum were highest in ODG group, followed by LADG group, and then TLDG group(P<0.05). Moreover, there were similar outcomes between TLDG and ODG in terms of tumor resection and the lymph node dissection, followed by LADG(P<0.05). About the operation-related costs, TLDG group was significantly higher than LADG and ODG group (P=0.000<0.001).Conclusion:Choosing the right patient, the delta-shaped anastomosis in TLDG of gastric cancer is a safe procedure for Billroth I digestive reconstruction, which is a less invasive surgical method and makes patients restore more quickly compared with ODG and LADG. Meanwhile, there were similar outcomes between TLDG and ODG in terms of tumor resection and the lymph node dissection, but the related costs of TLDG was higher than LADG and ODG group.