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      Laparoscopic Gastric Resection for Gastric Cancer: Is Intracorporeal Anastomosis Necessary?

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          Abstract

          Background and Objective:

          In surgical dissection, laparoscopic approach and open techniques do not differ significantly, but there is still no consensus on how anastomosis should be performed in both cardia and distal gastric tumors. Anastomosis can be performed by laparoscopy-assisted mini-laparotomy or by intracorporeal suture techniques. In this study, we aim to present our four years of clinical experience and short-term surgical results from 133 cases in order to evaluate the necessity of laparoscopic anastomosis.

          Methods:

          This study was approved by Ethics Committee (No: 1-8-19, date: 14/01/2019). Patients who underwent curative resection with the diagnosis of gastric adenocarcinoma between January 2014 and January 2018 in the Ankara University Surgical Oncology Department were included in the study.

          Results:

          Of the 133 patients included in the study, 108 (81.2) were male and the mean age was 60.51 ± 12.0 years. The time of anastomosis was significantly longer in patients undergoing intracorporeal anastomosis (p = 0.021). The incidence of anastomotic leakage was significantly higher in the group undergoing intracorporeal anastomosis (p = 0.004).

          Conclusions:

          We think that esophagojejunostomy and jejunojejunostomy anastomoses in patients undergoing total gastrectomy should be performed with intracorporeal techniques in terms of benefit risk assessment. We believe that it is more feasible to continue the case with mini laparotomy when anastomosis is reached in patients who are planned to have gastrojejunostomy. In addition, in terms of intracorporeal anastomoses and advanced laparoscopic techniques, intracorporeal anastomoses performed in gastric cancer surgery for a laparoscopist who has completed the learning curve do not appear to be very different in terms of anastomosis safety.

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          Most cited references 24

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          Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy.

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            Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended para-aortic D3 lymphadenectomy (JCOG9501).

            The impact of overweight on the outcome of gastrectomy with lymphadenectomy is controversial, and data from a well-controlled, randomized study are needed to identify a possible relationship. We used data from 523 patients registered for a prospective randomized trial comparing D2 and extended para-aortic D3 lymphadenectomy to compare the effects of body mass index (BMI) and the extent of lymphadenectomy for the development of general or major surgical complications (anastomotic leakage, abdominal abscess, and pancreatic fistula). Seventy-seven patients were classified as overweight with BMI >or= 25, and 38 and 39 of these patients underwent a D2 or D3 lymphadenectomy, respectively. Among the 446 patients classified as nonoverweight with BMI < 25, 225 received D2 and 221 received D3 lymphadenectomy. Surgical complications, operation time, and blood loss were statistically significantly associated with BMI, and logistic regression analysis revealed that overweight directly affected the occurrence of surgical complications even after considering operation time and blood loss as intermediate factors instead of outcome variables. Among patients undergoing D2 lymphadenectomy, being overweight increased the risk for surgical complications and blood loss, whereas overweight was associated with only blood loss and operation time among patients receiving D3 lymphadenectomy. Overweight increased the risk of surgical complications in patients undergoing gastrectomy both directly and indirectly through operation time and blood loss. The impact of overweight on surgical complications was more evident in patients undergoing a D2 dissection.
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              Super-extended (D3) lymphadenectomy in advanced gastric cancer.

              To analyze our experience with D3 lymphadenectomy in the treatment of advanced GC with specific reference to post-operative morbidity and mortality, incidence of para-aortic node (PAN) metastases, and long-term prognosis.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                Sep-Oct 2020
                : 36
                : 6
                : 1177-1182
                Affiliations
                [1 ]Ersen Ogun, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
                [2 ]Unal Ali Ekrem, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
                [3 ]Cemil Yuksel, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
                [4 ]Culcu Serdar Ankara Oncology Hospital, Surgical Oncology, Ankara, Turkey
                [5 ]Bascseken Ilksen Salim Diyarbakır Oncology Hospital, Surgical Oncology, Diyarbakır, Turkey
                [6 ]Mercan Umit, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
                [7 ]Demirci Salim, Ankara University, General Surgery, Surgical Oncology, Ankara, Turkey
                Author notes
                Correspondence: Ogun Ersen, MD. Lecturer, General Surgery and Surgical Oncology Specialist, Ankara University Faculty of Medicine, Department of General Surgery, Surgical Oncology Clinic, Mamak, Ankara, Turkey. E-mail: ogunersen@ 123456hotmail.com
                Article
                PJMS-36-1177
                10.12669/pjms.36.6.1915
                7501006
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article

                stomach neoplasms, laparoscopy, gastrectomy

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