Curative Effect Analysis Of Intracorporeal Uncut-Roux-en-Y Anastomosis In Digestive Tract Reconstruction After Laparoscopic Distal Gastrectomy

Aims:To compare the safety and short-term curative effect of intracorporeal Uncut-Roux-en-Y and Roux-en-Y anastomosis in laparoscopic distal gastrectomy for gastric cancer;To Explore the potential application value of intracorporeal Uncut-Roux-en-Y anastomosis in laparoscopic distal gastrectomy.Materials and methods:A retrospective study was carried out to analyse Clinical data of 165 gastric cancer patients who received laparoscopic distal D2 radical gastrectomy with intracorporeal anastomosis in Fujian Provincial Hospital and The First Afilliated Hospital of Fujian Medical University from January 2016 to December 2019.According to the methods of anastomosis,patients were decided into intracorporeal Uncut-Roux-en-Y(URY)and Roux-en-Y(RY)anastomotic group.The intra-operative conditions,functional recovery of digestive tract,postoperative complications,and conditions of post-operative follow-up were compared between the two groups.The measured data were statistically analyzed by t test or Mann-Whitney U test;The sort variables were compared by X~2test or Fisher’s exact test.Results:All the 165 patients completed laparoscopic distal D2 radical gastrectomy with intracorporeal anastomosis successfully,including 80 cases in URY group and85 cases in RY group.There were no significant differences in baseline data,number of harvested lymph nodes and distance from resection margin to tumor edge between the two groups(all P>0.05).As compared to the RY group,the URY group had shorter maximum tumor diameter[3.1(0.5～7.5)cm vs.3.5(0.5～10)cm,P=0.029],longer operation time[(232.93±44.99)min vs.(189.12±51.19)min,P=0.001],but shorter anastomotic time[(41.26±8.33)min vs.(49.07±8.34)min,P=0.001],lesser intra-operative bleed loss[100(20～300)ml vs.150(30～500)ml,P=0.001],earlier postoperative intestinal exhaust[2(1～3)d vs.3(1～5)d,P=0.001],shorter time to first liquid diet[2(2～3)d vs.4(1～8)d,P=0.001],shorter postoperative hospital stay[8(6～14)d vs.8(5～22)d,P=0.001],lower incidence of Roux-en-Y stasis syndrome(RSS)[0%(0/80)vs.7.1%(6/85),P=0.045],all had significant differences(P<0.05).To except RSS,there were no significant differences in morbidity of postoperative complications[7.5%(6/80)vs.10.6%(9/85),P=0.490],in grade II and above morbidity of complications[0(0%)vs.2.4%(2/85),P=0.497].Follow-up for 6 months after operation showed that all patients were alive without tumor recurrence,and the endoscopic classifications of Residual food,Gastritis,and Bile reflux were no significant differences between two groups(all P>0.05).No patient had recanalization of the closed input loop of gastrojejunal anastomosis in URY group.Conclusions:Intracorporeal Uncut-Roux-en-Y anastomosis in laparoscopic distal radical gastrectomy for gastric cancer is safe,effective and easier to operate.Simultaneously,it can efficiently reduce the incidence of Roux-en-Y stasis syndrome.