• Asian Pacific Journal of Cancer Prevention
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• 제15권16호
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• pp.6733-6736
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• 2014

Background: Despite the growing acceptance of laparoscopic colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. Recently, natural orifice specimen extraction (NOSE) and intracorporeal anastomosis have been proposed to minimize abdominal wall trauma and improve the quality of laparoscopic colon resections Objective: To evaluate the feasibility and safety of a new approach combining intracorporeal delta-shaped anastomosis and transvaginal specimen extraction for totally laparoscopic sigmoid colectomy. Materials and Methods: Mobilization of bowel and dissection of lymph nodes were performed laparoscopically. After both proximal and distal incisal edges about 10.0 cm distance from sigmoid neoplasm were transected with an Endoscopic Linear Cutter-Straight, a small incision about 1.0 cm was created on the each colon wall of the contralateral side of the mesentery. Then anvils of an Endoscopic Linear Cutter-Straight were inserted into each colon through the small incisions, and incision and anastomosis between the walls of each colon were performed with a linear stapler. A V-shaped anastomosis was made on the wall and the remnant openings was reclosed with the Endoscopic Linear Cutter-Straight. The culdotomy was enlarged with laparoscopic ultrasound dissector. Transvaginal extraction of specimens was accomplished through a wound protector. Results: Surgery was performed for 11 patients with sigmoid cancer. No intraoperative complications or conversions occurred. The mean operating time was 132 min. All the patients were treated laparoscopically without any postoperative complications. Conclusions: The procedures of intracorporeal delta-shaped anastomosis and transvaginal specimen extraction are safe and oncologically acceptable for selected colon cancer cases.

• Journal of Gastric Cancer
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• 제15권2호
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• pp.105-112
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• 2015

Purpose: Intracorporeal anastomosis is the most difficult procedure during pure single-incision distal gastrectomy (SIDG) that affects its generalization. We introduced unaided delta-shaped anastomosis (uDelta), a novel anastomosis technique, for gastroduodenostomy after pure SIDG, and compared the results with those of previously reported Roux-en-Y anastomosis (RY). Materials and Methods: Between March 2014 and March 2015, SIDG with D1+ lymph node dissection was performed for early gastric cancer through a 2.5-cm transumbilical incision without any additional port. uDelta was performed by the operator alone, without any intracorporeal assistance. Results: uDelta was performed on 11 patents, and uncut RY was performed on 5-patients without open or multiport conversion. R0 resection was performed in all cases. No significant differences were observed in mean age and body mass index between patients who underwent uDelta or RY. Mean operation times were $214.5{\pm}36.2$ minutes for uDelta and $240.8{\pm}65.9$ minutes for RY, which was not significantly different. Reconstruction time for uDelta was shorter than that for RY, with marginal statistical significance ($26.1{\pm}8.3$ minutes vs. $38.0{\pm}9.1$ minutes, P=0.05). There were no intraoperative transfusions, 30-day mortality, or anastomosis-related complications in either group. Average length of hospital stay was $8.2{\pm}1.9$ days in the uDelta group and $7.2{\pm}0.8$ days in the RY group (P=0.320). Conclusions: After carefully considering indications, uDelta can be a feasible and can be a reproducible reconstruction method after SIDG in early gastric cancer.

• Journal of Gastric Cancer
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• 제23권4호
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• pp.561-573
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• 2023

Purpose: This study aimed to compare the long-term functional and patient-reported outcomes between intra-corporeal delta-shaped gastroduodenostomy and gastrojejunostomy after laparoscopic distal gastrectomy for gastric cancer. Materials and Methods: We retrospectively reviewed clinicopathological data from 616 patients who had undergone laparoscopic distal gastrectomy for stage I gastric cancer between January 2015 and September 2020. Among them, 232 patients who had undergone delta-shaped anastomosis and another 232 who had undergone Billroth II anastomosis were matched using propensity scores. Confounding variables included age, sex, body mass index, physical status classification, tumor location, and T classification. Postoperative complications, nutritional outcomes, endoscopic findings, and quality of life (QoL) were compared between the 2 groups. Results: No significant differences in postoperative complications or nutritional parameters between the two groups were observed. Annual endoscopic findings revealed more residual food and less bile reflux in the delta group (P<0.001) than in the Billroth II group. Changes of QoL were significantly different regarding emotional function, insomnia, diarrhea, reflux symptoms, and dry mouth (P=0.007, P=0.002, P=0.013, P=0.001, and P=0.03, respectively). Among them, the delta group had worse insomnia, reflux symptoms, and dry mouth within three months postoperatively. Conclusions: Long-term nutritional outcomes and QoL were comparable between the delta and Billroth II groups. However, more residual food and worse short-term QoL regarding insomnia, reflux symptoms, and dry mouth were observed in the delta group. Longer fasting time before endoscopic evaluation and short-term symptom management would have been helpful for the delta group.

• Journal of Gastric Cancer
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• 제19권3호
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• pp.355-364
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• 2019

Totally laparoscopic distal gastrectomy (TLDG) frequently involves the use of delta shaped gastroduodenostomy (DSG) for intracorporeal anastomosis. However, DSG has some drawbacks, and the book binding technique (BBT) was developed as a new technique to overcome these drawbacks. Subsequently, this technique was further improved with the development of modified book binding technique (MBBT). This study evaluated the safety and feasibility of MBBT in patients undergoing TLDG. Thirty-three patients who underwent TLDG with MBBT were retrospectively evaluated. The mean operation time was $277.6{\pm}37.1minutes$, including $51.9{\pm}15.7minutes$ for reconstruction. Two patients had anastomosis-related complications, one patient with stricture after leakage and 1 patient with stenosis. The former patient was treated with endoscopic balloon dilatation, and the latter was managed conservatively; neither required re-operation. MBBT is a safe and feasible technique, with acceptable surgical outcomes. It may be a good alternative option for the treatment of intracorporeal anastomosis in patients undergoing TLDG.

• Journal of Gastric Cancer
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• 제10권2호
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• pp.69-74
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• 2010

Purpose: Laparoscopic gastrectomy has been common treatment modality for gastric cancer. But, most surgeons tend to perform laparoscopy-assisted distal gastrectomy using epigastric incision. Delta-shaped anastomosis is known as intracorporeal gastroduodenostomy, but it is technically difficult and needed many staplers. So we tried to find simple and economical method, here we report on the results of liner-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy. Materials and Methods: We retrospectively reviewed the medical records of 25 patients who underwent totally laparoscopic distal gastrectomy using liner-shaped anastomosis at School of Medicine, Ajou University between January to October 2009. The indication was early gastric cancer as diagnosed by preoperative workup, the anastomoses were performed by using laparoscopic linear stapler. Results: There were 12 female and 13 male patients with a mean age of $55.6{\pm}11.2$. The following procedures were performed 14 laparoscopic gastrectomies, 11 robotic gastrectomies. The mean operation time was $179.5{\pm}27.4$ minutes, the mean anastomotic time was $17.5{\pm}3.4$ minutes. The mean number of stapler cartridges was $5.6{\pm}0.8$. Postoperative complication occurred in one patient, anastomotic stenosis, and the patient required reoperation to gastrojejunostomy. The mean length of postoperative hospital stay was $6.7{\pm}1.0$ days except the complication case, and there was no case of conversion to open procedure and postoperative mortality. Conclusions: Linear-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy is technically simple and feasible method.

• Journal of Gastric Cancer
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• 제22권3호
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• pp.248-259
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• 2022

Purpose: To overcome the technical difficulties of single-incision laparoscopic distal gastrectomy (SILDG), needle grasper (Endo Relief^TM)-assisted SILDG (NASILDG) was developed. Here, we compared the operative convenience and postoperative outcomes between SILDG and NASILDG. Materials and Methods: A needle grasper was inserted into the right upper abdomen and used in the NASILDG. We retrospectively reviewed patients who underwent D1 + dissection and delta-shaped Billroth I anastomosis with SILDG or NASILDG performed by a single surgeon between September 2015 and August 2018. Results: The SILDG (male, 50.0%) and NASILDG (male, 60.0%) groups included 10 and 15 patients, respectively. The operative time without combined operation and anastomosis was significantly shorter in the NASILDG group. Early complications and scar characteristics were not significantly different between the two groups. Conclusions: By adding a needle grasper, SILDG became more convenient without decreasing cosmetic results. NASILDG could be a recommended method to reduce the technical difficulty of SILDG.

• Journal of Gastric Cancer
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• 제19권1호
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• pp.111-120
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• 2019

Background: Billroth I anastomosis is one of the most common reconstruction methods after distal gastrectomy for gastric cancer. Intracorporeal Billroth I (ICBI) anastomosis and extracorporeal Billroth I (ECBI) anastomosis are widely used in laparoscopic surgery. Here we compared ICBI and ECBI outcomes at a major gastric cancer center. Methods: We retrospectively analyzed data from 2,284 gastric cancer patients who underwent laparoscopic distal gastrectomy between 2009 and 2017. We divided the subjects into ECBI (n=1,681) and ICBI (n=603) groups, compared the patients' clinical characteristics and surgical and short-term outcomes, and performed risk factor analyses of postoperative complication development. Results: The ICBI group experienced shorter operation times, less blood loss, and shorter hospital stays than the ECBI group. There were no clinically significant intergroup differences in diet initiation. Changes in white blood cell counts and C-reactive protein levels were similar between groups. Grade II-IV surgical complication rates were 2.7% and 4.0% in the ECBI and ICBI groups, respectively, with no significant intergroup differences. Male sex and a body mass index (BMI) ${\geq}30$ were independent risk factors for surgical complication development. In the ECBI group, patients with a BMI ${\geq}30$ experienced a significantly higher surgical complication rate than those with a lower BMI, while no such difference was observed in the ICBI group. Conclusion: The surgical safety of ICBI was similar to that of ECBI. Although the chosen anastomotic technique was not a risk factor for surgical complications, ECBI was more vulnerable to surgical complications than ICBI in patients with a high BMI (${\geq}30$).

• Journal of Gastric Cancer
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• 제24권3호
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• pp.341-352
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• 2024

Purpose: Textbook outcome is a comprehensive measure used to assess surgical quality and is increasingly being recognized as a valuable evaluation tool. Delta-shaped anastomosis (DA), an intracorporeal gastroduodenostomy, is a viable option for minimally invasive distal gastrectomy in patients with gastric cancer. This study aims to evaluate the surgical outcomes and calculate the textbook outcome of DA. Materials and Methods: In this retrospective study, the records of 4,902 patients who underwent minimally invasive distal gastrectomy for DA between 2009 and 2020 were reviewed. The data were categorized into three phases to analyze the trends over time. Surgical outcomes, including the operation time, length of post-operative hospital stay, and complication rates, were assessed, and the textbook outcome was calculated. Results: Among 4,505 patients, the textbook outcome is achieved in 3,736 (82.9%). Post-operative complications affect the textbook outcome the most significantly (91.9%). The highest textbook outcome is achieved in phase 2 (85.0%), which surpasses the rates of in phase 1 (81.7%) and phase 3 (82.3%). The post-operative complication rate within 30 d after surgery is 8.7%, and the rate of major complications exceeding the Clavien-Dindo classification grade 3 is 2.4%. Conclusions: Based on the outcomes of a large dataset, DA can be considered safe and feasible for gastric cancer.

• Journal of Gastric Cancer
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• 제5권1호
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• pp.16-22
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• 2005

목적:최근 조기위암환자를 대상으로 복강경보조하 원위부 위적제술이 활발히 시행되고 있으나 전복강경하 원위부 위절제술은 복강 내 위장관 문합의 어려움 때문에 아직까지 활성화되어 있지 않다. 이에 저자들은 복강경용 선형 자동 문합기를 이용한 복강 내 위십이지장 문합술을 통한 전복강경하 원위부 위절제술의 초기 경험을 통하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 2004년 6월부터 9월까지 가톨릭대학교 의과대학 성모자애병원 외과에서 조기위암으로 진단되어 전복강경하 원위부 위절제술을 시행받은 환자 8명을 대상으로 하였으며 복강 내 위십이지장 문합에는 복강경용 선형 자동 문합기를 이용한 델타형 문합 밥법을 이용하였다. 대상 환자에 대한 수술 관련 사항(수술 및 문합에 소요된 시간), 수술의 경과와 임상병리학적인 결과를 통한 근치도를 조사하였다. 결과: 수술 시간은 $369.4\pm62.5$분, 문합에 소요된 시간은 $45.1\pm14.4$분이었으며 증례의 증가에 따라 점차 단축되었다. 문합에 사용한 자동 문합기의 수은 $7.1\pm0.6$개였다. 절제 림프절은 $31.9\pm13.1$개였으며 개복 수술로 전환한 예는 없었다. 수술 후 첫 가스 배출은 $2.8\pm0.5$일, 첫 유동식 섭취는 $4.1\pm0.8$일, 재원 기간은 $10.3\pm4.1$일이었다. 수술과 관련된 합병증은 없었다. 결론: 델타형 위십이지장 문합을 이용한 전복강경하 원위부 위절제술은 기술적으로 용이하였고 조기위암환자에서 복강경 수술의 장점을 최대화할 수 있는 최소침습수술의 하나라고 생각된다.0\%$), 위 중부 20예($21\%$), 위 상부 18예($9\%$)였다. 위암 환자 중 흡연력이 있는 경우는 56명, 없는 경우는 40명이었고, 음주력이 있는 경우는 45명, 없는 경우는 51명이었다. 환자군에서 MTHFR의 유전자 다형성은 C/C 18($19\%$), C/T 59($61\%$), T/T 19($20\%$)였고, 대조군에서는 C/C 116($40\%$), C/T 103$40\%$), T/T 68($24\%$)이었다(P=0.045). 암의 위치에 따른 MTHFR유전자형의 분포는 위 하부에서 C/C 16($28\%$), C/T & T/T 42($77\%$)이었고, 위 중부 및 상부에서 C/C 2($5\%$), C/T & T/T 36($75\%$) 이었다(P=0.006). 환자군 내에서 흡연력 유무에 따른 MTHFR유전 자형의 분포는 흡연력이 있을 때 C/C 13($23\%$), C/T & T/T 43($77\%$)이었고, 흡연력이 없을 때 C/C 5($12\%$), C/T & T/T 35 ($88\%$)였다(P=0.189). 환자군 내에서 음주력 유무에 따른 MTHFR유전자형의 분포는 음주력이 있을 때 C/C 12($26\%$), C/T & T/T 33($74\%$)이었고, 음주력이 없을 때 C/C 6($12\%$),