Surgical Safety And Effectiveness Of Totally Laparoscopic Total Gastrectomy Via Modified Overlap Method Versus Extracorporeal Circular Anastomosis Method

Objective Compare the differences between modified Overlap method and extracorporeal circular anastomosis method to investigate the application value of modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 115 patients with gastric cancer who underwent TLTG between January 2016 and September 2018 at the department of surgical oncology in our hospital were collected.51 Patients using modified Overlap method and 64 patients using extracorporeal circular anastomosis method were respectively allocated into modified Overlap group and extracorporeal anastomosis group.All the patients underwent D2 lymph node dissection.Patients in modified Overlap group underwent totally laparoscopic side-to-side esophagojejunostomy.Patients in extracorporeal anastomosis group underwent laparoscopic-assisted end-to-side esophagojejunostomy.Collect statistics(1)intra-operative statistics:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,the length of upper cutting edge and the length of minilaparotomy;(2)post-operative recovery:postoperative pain,time to first flatus,time to first fluid diet,duration of postoperative hospital stay;(3)anastomotic complications:anastomotic fistula,anastomotic hemorrhage and anastomotic obstruction.Measurement data with normal distribution were represented as(?)±s and comparison between groups was analyzed using the independent-sample t test.Comparison of count data was analyzed using the chi-square test or Fisher exact probability or rank test.Anastomotic complications were analyzed using single factor and multifactor analysis.single factor analysis used the chi-square test and multifactor analysis multiple logistic regression analysis.Results All the 115 patients underwent successful LTG,without conversion to open surgery.(1)intra-operative statistics:total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,the length of upper cutting edge and the length of minilaparotomy were respectively(234.4±11.1)minutes,(29.4±2.1)minutes,(52.6±14.1)ml,42.0±12.7,(2.0 ± 0.3)cm and(5.1 ± 0.4)cm in modified Overlap group and(231.0±10.7)minutes,(29.2±2.2)minutes,(50.0±13.3)ml,39.6±10.4,(2.2±0.4)cm and(8.2 ± 0.4)cm in extracorporeal anastomosis group.There are no statistically significant differences in total operation time,time of esophagus-jejunum anastomosis,volume of intraoperative blood loss,number of lymph node dissected,the length of upper cutting edge between modified Overlap group and extracorporeal anastomosis group(P>0.05).There is statistically significant difference in the length of minilaparotomy between modified Overlap group and extracorporeal anastomosis group(P<0.05).(2)post-operative recovery:mild postoperative pain,moderate postoperative pain,severe postoperative pain,time to first flatus,time to first fluid diet,duration of postoperative hospital stay were respectively 40,9,2,(2.9±1.0)days,(4.8±2.2)days,(11.7±2.8)days in modified Overlap group and 31,27,6,(3.9±1.4)days,(6.5±2.5)days,(13.0±3.1)days in extracorporeal anastomosis group,with statistically significant differences between modified Overlap group and extracorporeal anastomosis group(P<0.05).(3)anastomotic complications:patients in modified Overlap group were respectively complicated with 1 anastomotic fistula and 1 anastomotic hemorrhage,patients in extracorporeal anastomosis group were respectively complicated with 1 anastomotic fistula,1 anastomotic hemorrhage and 1 anastomotic obstruction,with no statistically significant difference between modified Overlap group and extracorporeal anastomosis group(P>0.05).They were improved by symptomatic treatment.Conclusion The safety and effectiveness of modified Overlap method are similar with extracorporeal anastomosis method.What’s more,it is less invasive and can speed up post-operative rehabilitation.Generally speaking,it is a safe and effective method for digestive tract reconstruction in TLTG.