A Modified Delta-shaped Gastroduodenostomy In Totally Laparoscopic Distal Gastrectomy For Gastric Cancer

Objective Delta-shaped gastroduodenostomy is a functional end-to-end technique tothe anastomosis between the posterior wall of the stomach and that of the duodenalbulb, using endoscopic linear staplers in totally laparoscopy. The present studyintroduced a modified delta-shaped gastroduodenostomy and accessed its safety,feasibility and clinical results in patients undergoing totally laparoscopic distalgastrectomy for gastric cancer.Methods A total of102patients with primary distal gastric cancer undergoing totallylaparoscopic distal gastrectomy with modified delta-shaped gastroduodenostomybetween January2013and December2013were enrolled. A retrospective study wasperformed using a prospectively maintained comprehensive database. Theclinicopathologic characteristics (including age, gender, BMI, preoperative nutritionlevel and nutritional support, history of abdominal surgery, preoperativecomplications and comorbidity diseases, tumor size, pathological TNM stage andpathologic type), intraoperative outcomes (including intraoperative blood loss,operative time, anastomosis time, extent of lymph node dissection and number ofdissected lymph nodes), postoperative outcomes (including the times to first flatus,fluid diet, soft diet and postoperative hospital stay; and anastomosis size), andpostoperative complications of the two groups were collected and summarized.Univariate and multivariate analyses were performed to estimate the predictive factorsfor postoperative morbidity.Results The eligible patients included74males and28females, with a mean age60.0±12.0years (range32to84years) and a mean BMI22.2±3.2kg/m2(range16.2to31.6kg/m2).One patient was diagnosed as gastric cancer with pyloric obstructionand11with hemorrhage (presented with melena). Thirty-nine patients with comorbidity included31with cardiovascular diseases (including high blood pressure,coronary heart disease and arrhythmia). The mean operation time was150.6±30.2min,the mean anastomosis time was12.2±4.2min, the mean blood loss was48.2±33.2ml,and the mean times to first flatus, fluid diet, soft diet and postoperative hospital staywere3.8±1.3days,5.0±1.0days,7.4±2.1days and12.0±6.5days, respectively. Twopatients with minor anastomotic leakage after surgery were managed conservatively;no patient experienced any complications around the anastomosis, such asanastomotic stricture or anastomotic hemorrhage. Univariate analysis showed that age,gastric cancer with hemorrhage and cardiovascular diseases combined weresignificant factors that affected postoperative morbidity (p<0.05). Multivariateanalysis found that gastric cancer with hemorrhage was the independent risk factor forthe postoperative morbidity (p<0.05). At a median follow-up of7months, no patientshad died or experienced recurrent or metastatic disease.Conclusions The modified delta-shaped gastroduodenostomy was technically safeand feasible, with easy operations and acceptable surgical outcomes, in patientsundergoing totally laparoscopic distal gastrectomy for gastric cancer, and thisprocedure may be promising in these patients.