Comparative Study Of Laparoscopic FETE Anastomosis And Open Esophageal Jejunal End-to-side Anastomosis In Total Gastrectomy

Objective:To Compare the safety and near-term effect of functional end-to-end anastomosis of esophagus and jejunum(FETE)using a linear cutting closure under laparoscopy and the safety and near-term effect of end-to-side anastomosis of esophagus and jejunum using a circular stapler under opening.It is hoped to provide reference and theoretical guidance for selecting the best surgical treatment for gastric cancer.Methods:Retrospective analysis of the clinical data of 70 patients who underwent radical total gastrectomy from September 2017 to August 2019 in the Department of General Surgery of Ningbo Yinzhou No.2 Hospital.According to different choices of gastrointestinal reconstruction after total gastrectomy,The patients were dividied into two groups,among which 39 cases underwent laparoscopic total gastrectomy and anastomosis,and were designated as the FETE group;31 cases were performed with total open gastrectomy and anastomosis,and were set as an open circular stapler group.Both groups of patients completed lymph node D2 dissection and both completed digestive tract reconstruction using Roux-en-Y.Excluded from the differences in general information such as age,BMI,and gender,the data of the two groups were analyzed.Observation indicators include 1)Intraoperative conditions such as surgical time,surgical bleeding volume,etc;2)postoperative Situation such as the time to resume eating,changes in postoperative nutritional indicators,time to remove the drainage tube,etc;3)postoperative complications,mainly the incidence of anastomotic complications,such as anastomotic bleeding,anastomotic stenosis,anastomosis Leakage,etc.;4)Follow-up after surgery,follow-up by telephone and outpatient clinic,both for half a year after surgery.Through the comparative analysis of the above indicators,the curative effect comparison of the two methods is performed.Results:There were no significant differences in clinical data(age,gender,body mass index(BMI),Lauren classification,degree of differentiation and stage,lymph node and vascular metastasis)in the two groups.Compared with the open group,the laparoscopic FETE group had a short time of first fluid intake after surgery [(4.46±1.97)day vs.(6.84 ± 4.52)day,P=0.01],the short-term half-fluid time for the first postoperative feeding [(8.41±3.24)day vs.(10.81±5.17)day,P=0.02],the drainage tube indwelling time is short [(8.72±2.31)day vs.(10.58±4.08)day,P=0.02],short hospital stay after surgery [(11.18±2.79)day vs.(14.26±3.12)day,P=0.00],the incidence of anastomotic stenosis was low [(0%)vs.(12%),P=0.02] and other advantages.There were no complications such as gastroparesis,other anastomotic complications(bleeding,perforation,fistula,ulcer),Roux arm twist in the two groups;number of lymph node dissections,exhaust time,and postoperative complications(small bowel obstruction,incision infection,abdominal abscess,lung infection,pancreatic fistula)and changes in the operation time,intraoperative blood loss,perioperative albumin,hemoglobin(Before surgery,3 days after surgery,1 week after surgery),there was no significant difference(P>0.05).Both groups were followed up for 6 months without long-term complications and recurrence.Conclusion:Both surgical methods are safe and feasible for gastrointestinal reconstruction after total gastrectomy.The FETE group has the following advantages,including fewer complications such as postoperative anastomotic stenosis,faster postoperative recovery and eating,and shorter drainage tube placement time,shorter postoperative hospital stay,etc.What’s more,the FETE group has favourable recent curative effect.