1 Patients and methods
1.1 A total of eighty patients diagnosed with GC were retrospectively enrolled in this study from January 2016 to June 2018 at the Department of Oncology II, General Hospital of Ningxia Medical University, China. Among all patients, forty cases received SPLT-TLTG surgery and the other forty received LATG surgery, respectively.
1.2 Inclusion and exclusion criteria:
Inclusion criteria as 1) The diagnosis was made based on electronic gastroscopy examination and confirmed by pathological examinations.
Exclusion criteria as 1) Established distant metastasis 2) Patients who received neoadjuvant radiotherapy and chemotherapy before the operation; 3) History of surgical treatments for gastric cancer.
1.3 Surgical procedures
Firstly,patients were intubated under general anesthesia and maintained a modified lithotomy position. Five-hole Trocars were placed routinely at the preparatory stage. (Fig. A). Secondly, the liver, abdominal cavity, pelvic cavity and mesentery were examined carefully. Patients with distant metastasis and invasion of perigastric organs were exclude from further operation. Then laparoscopic gastrectomy (total gastrectomy + D2 lymph node dissection) was conducted. Thirdly, the esophagogastric junction was ligated with a sterilized rope in SPLT group to facilitate the traction of the esophagus. A small pinhole was made by ultrasonic scalpel on the right side of the esophagus, about 3cm above the ligation rope (Fig. B). Then the jejunum was lifted away for 30cm to ligament of the Treitz. Another 1cm pinhole was made at the mesenteric margin. A side-to-side esophagojejunostomy(E-J) was performed through these two holes (Fig. C) and the entry hole was closed with a linear stapler (Fig. D). Next, a side-to-side jejunojejunostomy was performed between the afferent loop stump and the roux limb 40cm below E-J, meanwhile another entry hole was formed and closed. A drainage tube near the upper abdominal duodenal stump was placed after anastomosis was conducted. The sample bag of the stomach was removed through a small incision in the navel (Fig. E).
LAG: laparoscopic gastrectomy was performed conventionally as introduced before. Briefly, 5cm incisions were made below the xiphoid process before the digestive tract reconstruction which was performed similarly as in open surgery (Fig. F).
1.4 Clinical parameters
Intraoperative and postoperative clinical parameters include total operation time, digestive tract reconstruction time, intraoperative blood loss, numbers of retrieved lymph nodes (LNs), postoperative off-bed activities time, time to first flatus, time to first oral food intake and total postoperative hospital stay were collected. Prognosis and complications include postoperative anastomotic leakage, anastomotic bleeding, anastomotic stricture, abdominal bleeding, intra-abdominal infection, disturbance of gastric emptying, pancreatic and biliary fistula were also collected.
Numerical rating scale (0–10) was employed to assess the postoperative pain: 0: no pain; 1–3: mild pain; 4–6: moderate pain; 7–10: severe pain. For moderate pain, oral clofenaceine tablets or paracetamol and oxycodone tablets were prescribed, and pethidine hydrochloride was prescribed for severe pain .
1.5 Follow up
All patients were followed up by outpatient clinic or telephone. Clinical parameters including imaging, blood routine test, serum biochemical test, tumor marker detection, abdominal CT and gastroscope were evaluated as appropriate.
1.6 Statistical analysis
All statistical calculations were conducted using Statistical Product and Service Solutions (SPSS) version 18.0 statistical software. Continuum data was described as means ± standard deviation and analyzed by Student t-test. Kaplan-Meier method was applied when depicting the survival curve. P values < 0.05 were considered as statistically significant.