Selection Techniques And Prospects Of The Digestive Tract Reconstruction In Laparoscopic Radical Gastrectomy For Gastric Cancer

Gastric cancer(GC)is a common digestive malignant tumor.Globally,(1)there are 950,000 new GC cases every year;(2)It ranks the fourth among the most common malignant tumor;(3)and it is the third cause of death among all tumors.China has a high incidence of gastric cancer.The annual incidence of GC in China accounts for about 40% of the world,with an increasing and low-aging tendency.Radical gastrectomy based comprehensive treatment mode is still the treatment for gastric cancer at present,and the biggest problem faced after radical gastrectomy for GC is the reconstruction of digestive tract.Through the history of digestive tract reconstruction is more than 130 years,during which best operation modes for gastrectomy have appeared,and laparoscopic gastrectomy,which has only been developed for more than 20 years,has gotten the favor of surgeons due to its small trauma,less bleeding,fast postoperative recovery,etc.During the over 20 years of development,best reconstruction modes for laparoscopic gastrectomy have been formed constantly: postoperative anastomosis modes Billroth-I,Billroth-II and Roux-en-Y after distal laparoscopic gastrectomy;fundoplication after esophageal stump-front wall gastric anastomosis,gastro-esophageal tubular anastomosis,anastomosis of vestige stomach and oesophagus after posterior laparoscopic gastrectomy;and postoperative Roux-en-Y anastomosis after laparoscopic-assisted total gastrectomy.Its reconstruction modes must be selected and optimized according to the patients’ basic condition,the gastric volume to be retained,tumor staging,configuration of laparoscopy-related equipments,and surgeons’ level,and the like.And the laparoscopy-related equipments have also been rapidly developed during these 20 years.The emergence of 2D HD laparoscopy,3D laparoscopy,and Leonardo’s robot,etc.ensures the effects and quality of digestive tract reconstruction after laparoscopic gastrectomy.Since the tumor specimens need to be taken out from the abdominal incision,therefore,the abdominal incision can be made fully use of for digestive tract reconstruction after laparoscopic gastrectomy.namely,Laparoscopic-assisted total gastrectomy(Laparoscopic-assisted gastrectomy LAG).Operations such as stapler placement,gastrojejunostomy,enhancement of duodenal stump and pneumoperitoneum reconstruction,all can be successfully completed through the small abdominal incision,which greatly reduces the difficulty of operation and obviously shortens the operation time and saves cost.This is also a major reason why domestic and foreign gastrointestinal surgeons choose for the digestive reconstruction after gastrectomy.So,the author summarized the domestic and foreign literatures on the selection skills and prospects of digestive reconstruction modes after laparoscopic gastrectomy,and reviewed combined with the author’s experience in advanced reverse-puncture staple placement,pneumoperitoneum reconstruction,and laparoscopic esophagojejunostomy after laparoscopic-assisted total gastrectomy.(Laparoscopic-assisted total gastrectomy LATG)...