FORMATION OF EZOFAGOEYUNO-ANASTOMOSIS AFTER LAPAROSCOPIC TOTAL GASTRECTOMY AND LAPAROSCOPY-ASSISTED GASTROECTOMY IN PATIENTS WITH GASTRIC CANCER

Анотація

At present, stomach cancer is the second most common cause of cancer death. There are two options for surgical treatment of potentially curable patients with non-metastatic gastric cancer: laparoscopic and open gastrectomy. Accordingly, there is a need to discuss options for the formation of esophago-jejuno anastomosis techniques that would be maximum simple, reliable, safe and cost-effective for the patient. The article investigates methods of formation of different types of esophageal and intestinal anastomoses, in particular, in laparoscopic total gastrectomy and laparoscopy-assisted gastroectomy. The results of 41 patients were analyzed in this work; 7 of them underwent laparoscopic total gastrectomy with the formation of intracorporeal anastomosis, and 34 patients underwent laparoscopy-assisted total gastrectomy with formation of circumferential stapled anastomosis. There were 29 men and 12 women.

The mean age of patients was 57 ± 9 years; the Body Mass Index (BMI) was 25.0 ± 2.9. In order to predict a surgical risk, physical status of patients was estimated under the scale developed by the American Society of Anesthesiologists (ASA). Condition of 29 patients was estimated as ASA II, and of 12 others - as ASA III. Analysis of tumor characteristics allowed to determine the stage of cancer as II in 17 patients and as III in 24 patients. A choice of method of anastomosis formation depends on the surgeon’s experience, anatomical features of the patient, and economic component of consumables. All surgeries included into the research were completed laparoscopically. LTG with intracorporeal staple anastomosis was performed in 7 patients. In this group the average time of anastomosis formation was 51.2 ± 18.2 minutes. Flatulence was observed on 3.8 ± 1.1 day, feeding began on 6.1 ± 1.1 day. A discharge took place on 10.5 ± 2.5 day. 34 patients underwent surgeries under the LAG technique, 23 of them had anastomosis formation of the first type and 11 – of the second one. The mean time of anastomosis formation was 48.3 ± 9.0 and 45.1 ± 7.0 minutes respectively. First flatus was on 3.9 ± 1.0 and 3.5 ± 1.1 day. The patient was discharged from hospital on 9.4 ± 2.9 day if there was formation of the first type, and on 9.3 ± 1.7 day if there was the second one. Postoperative complications are given in Table 3. There were no cases of in-hospital and thirty-day mortality. Complications were found in 3 patients in the LTG group. The patient was unable to form anastomosis but found an intra-abdominal abscess and there was bleeding into the anastomotic lumen. The patients in the LAG group suffered 7 complications, including 3 failures of anastomosis, 1 intra-abdominal abscess, 2 cases of bleeding into the anastomotic lumen, 1 anastomotic stricture. While analyzing advantages and disadvantages of the approaches used in the formation of EEA, it should be noted that both intra- and extracorporeal approaches have their advantages and disadvantages. Thus, LTG meets all the criteria of mini-invasive interventions in the sense of gentle abdominal wall treatment and reduction of pain in postoperative period. The formation of the anastomosis in the abdominal cavity occurs without tension, the injury to the surrounding organs is less, which promotes faster recovery of intestinal function and fully corresponds to the "no touch tumor" principle, which are obviously the advantages of this technique. In our opinion, the presented method of intracorporeal formation of EEA is the simplest among existing ones, but it also requires significant skills from a surgeon in mastering handmade sutures. The main advantage of the open anastomosis is the economic component.