Evaluation of modified Overlap method in digestive tract reconstruction after totally laparoscopic total gastrectomy for gastric cancer

Objective To evaluate the clinical effect of modified Overlap method in digestive tract reconstruction of totally laparoscopic total gastrectomy(TLTG) for gastric cancer. Methods The data of 86 patients with gastric cancer who underwent TLTG from January 2014 and January 2017 were collected from the First Hospital of Lanzhou University.All the patients underwent D2 lymphadenectomy.Forty-four patients′ digestive tracts were reconstructed with traditional Overlap method (control group), and 42 patients′ digestive tracts were reconstructed with modified Overlap method (modified group). The intraoperative and postoperative conditions, postoperative tumor-free survival, tumor recurrence and metastasis were compared between the two groups.Follow up lasted as of February 2018. Results TLTG was successfully performed in both groups, and no case was converted to laparotomy.The time of esophagojejunostomy ((20.4±2.3) min vs.(46.5±4.4) min, t=9.493), total operation time ((253.3±12.8) min vs.(278.6±14.9) min, t=5.462) in the modified group were significantly shorter than those in the control group, and there were significant differences between the two groups (all P 0.05). The two groups were followed up for 12~25 months.No recurrence or metastasis occurred. Conclusion Compared with traditional Overlap method, the modified Overlap method can simplify the anastomotic procedures, shorten operation time and achieve an effective and reliable anastomosis effect after TLTG. Key words: Gastric neoplasms; Laparoscopy; Radical surgery; Esophagojejunostomy