Search

27 Background: A standard anastomotic configuration after right hemicolectomy is not well established, although short-term benefits of end-to-side anastomosis have been reported. This study was designed to assess the superiority of end-to-side anastomosis compared to side-to-side anastomosis after laparoscopic right hemicolectomy for colon cancer under an enhanced recovery program. Methods: Between September 2016 and August 2019, 130 patients (18–80 years) scheduled for laparoscopic right hemicolectomy were randomly assigned (1:1) to undergo end-to-side ( n = 65) or side-to-side ( n = 65) anastomosis. All patients underwent an enhanced recovery program with early diet and mobilization. The primary outcome was the cumulative recovery rate 7 days after surgery, defined as the percentage of patients who met all of the following recovery criteria: tolerated diet for 24h, analgesic-free, safe ambulation, and afebrile status without major complications. Results: The cumulative recovery rate did not differ between end-to-side (92.3%, 60/65) and side-to-side anastomosis (92.3%, 60/65) ( P = 1.000). Both approaches had similar cumulative recovery rates at 4, 5, and 6 days (end-to-side vs. side-to-side: 41.5% vs. 35.4%, P = 0.589; 73.8% vs. 63.1%, P = 0.257; 86.2% vs. 81.5%, P = 0.634; respectively) The median recovery time [interquartile range (IQR)] in the end-to-side and side-to-side groups was 105 [90-124] hours and 113 [84-139] hours, respectively ( P = 0.474), showing no significant difference. Length of stay [IQR] was similar in the end-to-side and side-to-side groups (5 [5–7] vs. 6 [5–7] days; P = 0.376). The 30-day complication rate (16.9% vs. 12.3%, P = 0.620), enhanced recovery program failure rate (10.8% vs. 7.7%, P = 0.763), and 30-day readmission rate (4.6% vs. 3.1%; P = 1.000) were not significantly different between the groups. Conclusions: This is the first randomized controlled trial showing that end-to-side anastomosis is not superior to side-to-side anastomosis in terms of short-term outcomes after laparoscopic right hemicolectomy. Clinical trial information: NCT02897531.

209 Background: Patients with gastric cancer that involves the upper part of the stomach should undergo total gastrectomy for their curative resection. Roux-en-Y reconstruction is the most common procedure followingtotal gastrectomy. However, this reconstruction causes them various postgastrectomy symptoms and problems of their nutritional status and QOL. Although the development of the new reconstruction to prevent these symptoms have being carried out, we have not generally established procedures. Methods: To compare the feasibility and the nutritional parameters of the patients with Roux-en-Y reconstruction with aboral pouch following total gastrectomy to the simple Roux-en-Y. From February 2011 to June 2014, sixty three patients with gastric cancer underwent total gastrectomy. We analyzed the short-term outcome of surgery and the nutritional parameters in two groups. Results: The aboral pouch was created as a side to side anastomosis approximately 50 cms distal to the esophagojejunostomy, 12 cm in length. Most nutritional parameters after surgery were similar in two groups. However, lymphocyte, serum albumin and prognostic nutritional index in aboral pouch group one year later were good tendency compared with simple Roux-en-Y group. Conclusions: Roux-en-Y reconstruction with aboral pouch might become one of the standard methods after total gastrectomy for gastric cancer.