Study On The Safety And Feasibility Of Totally Laparoscopic Totalgastrectomy

Objective:To analyze and compare the short-term effects and postoperative complications of laparoscopic-assisted total gastrectomy(LATG)and totally laparoscopic total gastrectomy(TLTG)in patients with Siewert II gastric cancer,in order to explore the safety and feasibility of totally laparoscopic total gastrectomy.Methods:Through retrospective analysis,the clinical data of Siewert Ⅱ gastric cancer patients who were admitted to hospital from January 1,2016 to December 31,2022 and underwent laparoscopic-assisted and totally laparoscopic total gastrectomy in the same treatment group were collected.A total of 284 patients were divided into LATG group(n=155)and TLTG group(n=129),including π type anastomosis group(n=58),Overlap anastomosis group(n=41)and reverse puncture anastomosis group(n=30).There was no significant difference in baseline data such as age,sex,body mass index(BMI),preoperative American society of anesthesiologists grade(ASA grade),tumor diameter,degree of differentiation of tumor,tumor T,N stage and pathological stage among the four groups.Observation indicators:(1)Operation condition:operation time and blood loss,etc.(2)postoperative recovery:the first anal exhaust,defecation time,postoperative indwelling abdominal drainage tube days,postoperative hospital stay and so on.(3)postoperative complications:anastomotic bleeding,stenosis,leakage and abdominal infection.(4)postoperative pathology:the number of total lymph node dissection,the distance of proximal margin and so on.(5)postoperative pain score on the 1st.3rd and 5th day after operation.Results:There was no significant difference in the total number of lymph nodes and the number of positive lymph nodes among the four groups(P>0.05).There was no significant difference in intraoperative blood loss,postoperative exhaust,defecation times,postoperative indwelling abdominal drainage tube times,postoperative hospital stay and postoperative complications(P>0.05).The average operation time was 254.1±74.0min in the LATG group,226.9±70 min in the reverse puncture group,240.2±67.7min in the Overlap group and 233.0±47.3min in the π group.There was no significant difference in operation time between each subgroup of TLTG and LATG group.The average incision size was 7.8cm±2.8cm in LATG group,3.8±1.0cm in reverse puncture group,4.4cm±0.9cm in Overlap group and 4.4cm±0.8cm in%group.The size of incision in each subgroup of TLTG was significantly smaller than that in LATG group(P<0.05).The proximal resected margin was 1.30±1.00cm in the LATG group,1.15±0.92 cm in the reverse puncture group,1.37±0.90 in the π group and 1.34±0.94cm in the Overlap group.Pairwise multiple comparison showed that there was no significant difference in the distance of proximal resected margin among each group(P>0.05).For postoperative pain score,average pain scores of LATG group,reverse puncture group,Overlap group and π group on the first day after surgery were 6.3±0.5,5.0±0.5,5.0±0.6,4.7±0.7,respectively.Average pain scores on 3rd day were 4.7±1.0,3.9±1.0,3.8±0.7,3.9±1.2,respectively.Average pain scores on 5th day were 1.6±0.5,1.4±0.6,1.7±0.5,and 1.6±0.6,respectively.Multiple comparative analysis showed that the pain scores of all TLTG subgroups on the first and third day after surgery were lower than those of LATG,with statistical difference(P<0.05).On the 5th day after surgery,there were no differences in pain scores among the four groups(P>0.05),There was no significant difference in pain scores among TLTG subgroups on all days(P>0.05).Conclusion:l.TLTG can ensure the safety of surgery and oncology,and will not increase the postoperative complications of patients,so it is safe and feasible.2.On the basis of fully mastering laparoscopic-assisted total gastrectomy and sufficient learning curve,TLTG surgery will not increase the difficulty and time of operation.3.TLTG assisted incision is shorter and more minimally invasive,and postoperative patients have lower pain scores and faster recovery,which is more in line with the concept of ERAS.Objective:The quality of life(QOL)of patients undergoing laparoscopic-assisted total gastrectomy(LATG)and totally laparoscopic total gastrectomy(TLTG)were compared by European Organization for Research and treatment of Cancer(European Organization for Research and Treatment of Cancer.EORTC)Core scale of quality of Life(QLQ-C30)and gastric cancer specific module scale(Quality of Life Questionnaire-Stomach 22 QLQSTO22).Methods:The quality of life scores of patients with gastric cancer who underwent LATG and TLTG for half a year in the first part were followed up by telephone.The deadline for follow-up was December 31,2022.Excluding the loss of follow-up,tumor recurrence and death during follow-up,a total of 150 patients were included,including LATG group(n=84)and TLTG group(n=66),including π group(n=30),Overlap group(n=25)and reverse puncture group(n=11).Observation indicators:the quality of life of the four groups of patients after operation.Results:Compared with LATG group,Overlap group and π group,the scores of postoperative eating restriction and dysphagia in reverse puncture group were significantly higher(P<0.05).There was no significant difference in other quality of life scores among the four groups(P>0.05).Conclusion:Except that reverse puncture esophagojejunostomy increases the symptoms of postoperative eating restriction and dysphagia to some extent,there is no significant difference in other quality of life between TLTG and LATG,so TLTG is safe and feasible.