@2024 Afarand., IRAN
ISSN: 2252-0805 The Horizon of Medical Sciences 2015;20(4):203-207
ISSN: 2252-0805 The Horizon of Medical Sciences 2015;20(4):203-207
Complications and Survival in Esophagojejunostomy after Total Gastrectomy; A Comparision of Stapler and Manual Suturing
ARTICLE INFO
Article Type
Original ResearchAuthors
Akhavanmoghadam J. (1 )Mohebbi H.A. (1 )
Taheri S.M. (* )
Nikkhah S. (2 )
(* ) Surgery Department, Medicine Faculty, Baqiytallah University of Medical Science, Tehran, Iran
(1 ) Surgery Department, Medicine Faculty, Baqiytallah University of Medical Science, Tehran, Iran
(2 ) Midwifery Department, Nursing and Midwifery Faculty, Shahid Beheshti university of medical science, Tehran, Iran
Correspondence
Address: Unit 33, West First Floor, No. 348, East 212 Street, Tehranpars, Tehran, IranPhone: +982177786673
Fax: +982177786673
tahermojtaba@gmail.com
Article History
Received: January 11, 2014Accepted: July 28, 2014
ePublished: February 19, 2015
ABSTRACT
Aims
Gastric cancer is the most common cancer in men and the third most
common cancer in women after breast cancer and colon. This study aimed to
compare the complications and survival of two manual and suturing and
suturing with stapler in esophagojejunostomy suturing followed by total
gastrectomy.
Materials & Methods In this historical cohort study, 116 patients requiring total Gastrectomy were studied with proximal Gastric and Cardia cancer referred to a hospital with census method. Patients were studied by age, gender, type of surgery, leakage and other complications and one-year survival rates during hospitalization and at least 12 months after surgery. Data analyzed by SPSS 20 software and Chi-square, Independent-T tests, Kaplan-Meier and Cox regression.
Findings Suturing in 40 patients (34.5%) was manually and in 76 patients (65.5%) was with stapler. In manual suturing, 6 (15%) and in stapler suturing 2 (2.6%) leakage happened, which was statistically different (p=0.18). Mean operation time was 273.9±50.7min in manual suturing and was 252.3±65.8 in stapler suturing which was statistically different (p=0.25). In manual suturing 8 (20%) and in stapler suturing 4 (5.3%) deaths occurred which was statistically different (p=0.009). One-year survival rate was 31% and median survival rate was 15 months. Age and stage of disease had the highest correlation with survival rate.
Conclusion Due to the lower leakage rate and mortality after surgery, manual suturing is more effective than suturing with stapler.
Materials & Methods In this historical cohort study, 116 patients requiring total Gastrectomy were studied with proximal Gastric and Cardia cancer referred to a hospital with census method. Patients were studied by age, gender, type of surgery, leakage and other complications and one-year survival rates during hospitalization and at least 12 months after surgery. Data analyzed by SPSS 20 software and Chi-square, Independent-T tests, Kaplan-Meier and Cox regression.
Findings Suturing in 40 patients (34.5%) was manually and in 76 patients (65.5%) was with stapler. In manual suturing, 6 (15%) and in stapler suturing 2 (2.6%) leakage happened, which was statistically different (p=0.18). Mean operation time was 273.9±50.7min in manual suturing and was 252.3±65.8 in stapler suturing which was statistically different (p=0.25). In manual suturing 8 (20%) and in stapler suturing 4 (5.3%) deaths occurred which was statistically different (p=0.009). One-year survival rate was 31% and median survival rate was 15 months. Age and stage of disease had the highest correlation with survival rate.
Conclusion Due to the lower leakage rate and mortality after surgery, manual suturing is more effective than suturing with stapler.
CITATION LINKS
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[21]Fujimoto S, Takahashi M, Endoh F, Takai M, Kobayashi K, Kiuchi S, et al. Stapled or manual suturing in esophagojejunostomy after total gastrectomy: A comparison of outcome in 379 patients. Am J Surg. 1991;162(3):256-9.
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[25]Zeraati H, Mahmoodi M, Kazemnejad MK, Mohagheghi MA. Prospective survival in gastric cancer patients and its related factors. J School Public Health Inst Public Health Res. 2005;3(4):1-2. [Persian]
[2]Herve J, Simoens Ch, Smets D, Thill V, Mendes Da Costa P. Mechanical esophageal anastomosis: Retrospective study of 56 patients. Jurnalul de Chirurgie Iaşi. 2009;5(1):34-44.
[3]Fox JG, Wang TC. Inflammation, atrophy, and gastric cancer. J Clin Invest. 2007;117(1):60-9.
[4]Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. Philadelphia: Elsevier; 2008.
[5]Heise K, Bertran E, Andia ME, Ferreccio C. Incidence and survival of stomach cancer in a high-risk population of Chile. World J Gastroenterol. 2009;15(15):1854-1862.
[6]Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90.
[7]Inoue M, Tsugane S. Epidemiology of gastric cancer in Japan. Postgrad Med J. 2005;81(957):419-24.
[8]Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, et al. Cancer statistics, 2006. CA Cancer J Clin. 2006;56(2):106-30.
[9]Movahedi M, Afsharfard A, Moradi A, Nasermoaddeli A, Khoshnevis J, Fattahi F, et al. Survival rate of gastric cancer in Iran. J Res Med Sci. 2009;14(6):367-73. [Persian]
[10]Sajadi A, Nouraei M, Mohagheghi MA, Mousavi- Jarrahi A, Malekezadeh R, Parkin DM. Cancer Occurrence in Iran in 2002, an internationalperspective. Asian Pac J Cancer Prev. 2005;6(3):359-63. [Persian]
[11]Yazdanbod A, Arshi S, Derakhshan MH, Sadjadi AR, Malekzadeh R. Gastric cardia cancer; the most common type of upper gastrointestinal cancer in Ardabil, Iran: An endoscopy clinic experience. Arch Irn Med. 2001:4(2):76-9. [Persian]
[12]Jain VK, Cunningham D, Rao S. Chemotherapy for operable gastric cancer: current perspectives. Indian J Surg Oncol. 2011;2(4):334-42.
[13]Lang SA, Gaumann A, Koehl GE, Seidel U, Bataille F, Klein D, et al. Mammalian target of rapamycin is activated in human gastric cancer and serves as a target for therapy in an experimental model. Int J Cancer. 2007;120(8):1803-10.
[14]Wang F, Li T, Zhang B, Li H, Wu Q, Yang L, et al. MicroRNA- 19a/b regulates multidrug resistance in human gastric cancer cells by targeting PTEN. Biochem Biophys Res Commun. 2013;434(3):688-94.
[15]Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg 2005;241(1):27-39.
[16]Dragovich T, Campen C. Anti-EGFRTargeted Therapy for Esophageal and Gastric Cancers: An Evolving Concept. J Oncol. 2009;2009:804108.
[17]Thong-Ngam D, Tangkijvanich P, Mahachai V, Kullavanijaya P. Current status of gastric cancer in Thai patients. J Med Assoc Thai. 2001;84(4):475-82.
[18]Zinner MJ, Ashley SW. Maingot's Abdominal Operations. 12th ed. China: McGraw-Hill Companies; 2013.
[19]Tudor S, Anton A, Purnichescu-Purtan R. Stapled esophagojejunal anastomoses: particular aspects of minimally invasive surgery and comparison with manual anastomoses: A single team experience. Chirurgia (Bucur). 2012;107(2):169-73.
[20]Takeyoshi I, Ohwada S, Ogawa T, Kawashima Y, Ohya T, Kawate S, et al. Esophageal anastomosis following gastrectomy for gastric cancer: Comparison of hand-sewn and stapling technique. Hepatogastroenterology. 2000;47(34):1026-9.
[21]Fujimoto S, Takahashi M, Endoh F, Takai M, Kobayashi K, Kiuchi S, et al. Stapled or manual suturing in esophagojejunostomy after total gastrectomy: A comparison of outcome in 379 patients. Am J Surg. 1991;162(3):256-9.
[22]Maroufizadeh S, Hajizadeh E, Baghestani A, Fatemi S. Prognostic factor for patients with gastric cancer using the Aalen’s additive hazards model. Koomesh. 2011;13(1):120- 6. [Persian]
[23]Celis J, Ruiz E, Berrospi F, Payet E. Mechanical versus manual suture in the jejunal esophageal anastomosis after total gastrectomy in gastric cancer. Rev Gastroenterol Peru. 2001;21(4):271-5.
[24]Shim JH, Oh SI, Yoo HM, Jeon HM, Park CH, Song KY. Short-term outcome of laparascopic versus open total gastrectomy: A matched-cohort study. Am J Surg. 2013;206(3):346-51.
[25]Zeraati H, Mahmoodi M, Kazemnejad MK, Mohagheghi MA. Prospective survival in gastric cancer patients and its related factors. J School Public Health Inst Public Health Res. 2005;3(4):1-2. [Persian]