SIMPLIFIED TECHNIQUE FOR RECONSTRUCTION OF THE DIGESTIVE TRACT AFTER TOTAL AND SUBTOTAL GASTRECTOMY FOR GASTRIC CANCER

Background

Laparoscopic surgery has been increasingly applied to gastric cancer surgery.Gastrointestinal tract reconstruction totally done by laparoscopy also has been achallenge for those who developed this procedure.

Aim

To describe simplified reconstruction after total or subtotal gastrectomy forgastric cancer by laparoscopy and the results of its application in a series ofcases.

Methods

In the last four years, 75 patients were operated with gastric cancer and two withGIST. Thirty-four were women and 43 men. The age ranged from 38 to 77 years withan average of 55 years. In two patients with GIST a total and a subtotalgastrectomy were performed. In the other 75 patients were done 21 totalgastrectomies and 54 subtotal. In all cancers, gastrectomy with D2 lymphadenectomywas completed with at least 37 lymph nodes removed. Was used in these operations amodified laparoscopic technique proposed by the authors consisting in a laterolateral esophagojejunal anastomosis with linear stapler in TG as well in STG, andreconstruction of the digestive continuity also in the upper abdomen.

Results

The intraoperative and immediate postoperative course were uneventful, except forone case of bleeding due to an opening clip, necessitating re-intervention. Theoperative time was 300 minutes, with no difference between total or subtotalgastrectomy. The number of lymph nodes removed varied from 28 to 69, averaging 37.Postoperative staging showed one case in T4 N2 M0; 13 in T2 N0 MO; 27 in T2 N1 M0;24 in T3 N1 M0 and 10 in T3 N2 M0. Complication in only one case was observed onthe 10th postoperative day with a small anastomotic leakage in esophagojejunalanastomose with spontaneous closure.

Conclusion

The patient''s evolution with no complications, no mortality and just one smallanastomotic leakage with no systemic repercussions is a strong indication of theliability and feasibility of this innovative technical method.