Curative Effect Analysis Of π-shaped Anastomosis And Overlap Anastomosis In Total Laparoscopic Gastrectomy For Locally Advanced Apper Gastric Cancer

Objective:To investigate the application value of π-shaped anastomosis in digestive tract reconstruction of totally laparoscopic total gastrectomy(TLTG)by comparing the clinical efficacy between π-shaped anastomosis and overlap anastomosis method.Methods:The clinical data of patients with locally advanced upper gastric cancer who underwent total laparoscopic gastrectomy in Shanxi Province Cancer Hospital from January 2017 to May 2019 were retrospectively analyzed.And they were divided intoπ-shaped anastomosis and overlap anastomosis.The operation,recovery and postoperative complications of the two groups were compared respectively.Results:A total of 99 patients met the inclusion and exclusion criteria,50 of them underwent esophagojejunostomy and 49 cases of π-shaped anastomosis,and they all underwent underwent complete laparoscopic total gastrectomy and no one case convert to open surgery.There was no significant difference in the general condition of patients,so they were comparable.(1)Operation:The time of operation in π-shaped anastomosis group was shorter than overlap anastomosis group [(204.94 ± 21.20)min vs(218.26 ± 27.22)min,P=0.008],and the time of esophagojejunostomy in π-anastomosis group was much shorter than overlap anastomosis group as well [(28.12 ± 4.56)ml vs(42.92 ± 5.26)ml,P<0.001].The difference of the estimated blood loss between overlap anastomosis group and π-shaped anastomosis group was not obvious.[(107.20±32.89)cm vs(112.45±39.40)cm,P=0.473],and the number of lymph nodes dissected between the two groups don’t have distinctively diffrence [(25.12±14.14)vs(22.59±10.47),P=0.315].Postoperative anatomical specimens showed that the distance between tumor and proximal margin in the group of overlap anastomosis was longer than that in the group of overlap anastomosis,and the difference was statistically significant [(4.67±0.79)cm vs(3.94±0.66)cm,P<0.01].(2)Postoperative recovery:The situation of postoperative intestinal function recovery rate between the group of esophagojejunal overlap anastomosis and the group of π type anastomosis was not appearently different(P>0.05).The relevant indicators included the first postoperative degulation time [(3.28±1.18)d vs(3.04±0.93)d,P=0.267],and the first postoperative defecation time [(4.04±1.11)d vs(4.25±0.95)d,P=0.320],liquid diet for the first time after time[(5.2+1.82)d vs(5.35+1.35)d,P=0.648),postoperative hospitalization days in the two groups [(15.68 + 2.49)d vs(14.84 + 3.04)d,P = 0.134).(3)Postoperative complications: in the group of esophageal jejunal overlap anastomosis,anastomotic leakage occurred in 1 case,anastomotic bleeding occurred in 1case,postoperative pulmonary infection occurred in 1 case(related to the patient’s long smoking history and not active postoperative sputum discharge),incision infection occurred in 1 case,and postoperative reflux esophagitis occurred in 6 cases.In the π-type anastomosis group,anastomotic leakage was found in 1 case,anastomotic stenosis in 1case,and postoperative reflux esophagitis in 1 case.The difference was statistically significant(P < 0.05).Conclusion:Compared with overlap anastomosis,π-shaped anastomosis of esophagus and jejunum has less operative time and incidence of postoperative complications,at the same time the dissection of lymph node,operative blood loss and postoperative intestinal recovery do not have distinctive difference.Therefore,π-shaped anastomosis is safe and feasible in the application of TLTG,which is worthy of clinical popularization and application.However,π-shaped anastomosis can’t ensure the negative incision margin when dissecting the esophagus.Thus,if the tumor location is too high,π-type anastomosis is not recommended,and overlap anastomosis can be considered for anastomosis.