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Effectiveness of preserved vagal nerve in totally laparoscopy radical distal gastrectomy: a matched‐paired cohort analysis

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Abstract

Background

The aim of this retrospective matched‐paired cohort study was to clarify the effectiveness of preserving the vagus nerve in totally laparoscopic radical distal gastrectomy (TLDG).

Methods

One hundred eighty-three patients with gastric cancer who underwent TLDG between February 2020 and March 2022 were included and followed up. Sixty-one patients with preservation of the vagal nerve (VPG) in the same period were matched (1:2) to conventional sacrificed (CG) cases for demographics, tumor characteristics, and tumor node metastasis stage. The evaluated variables included intraoperative and postoperative indices, symptoms, nutritional status, and gallstone formation at 1 year after gastrectomy between the two groups.

Results

Although the operation time was significantly increased in the VPG compared with the CG (198.0 ± 35.2 vs. 176.2 ± 35.2 min, P < 0.001), the mean time of gas passage in the VPG was significantly lower than that in the CG (68.1 ± 21.7 h vs. 75.4 ± 22.6 h, P = 0.038). The overall postoperative complication rate was similar between the two groups (P = 0.794). There was no statistically significant difference between the two groups hospital stay, total number of harvested lymph nodes, and mean number of examined lymph nodes at each station. During follow-up, the morbidity of gallstones or cholecystitis (8.2% vs. 20.5%, P = 0.036), chronic diarrhea (3.3% vs. 14.8%, P = 0.022), and constipation (4.9% vs. 16.4%, P = 0.032) were significantly lower in the VPG than in the CG in this study. Moreover, injury to the vagus nerve was found to be an independent risk factor for gallstone formation or cholecystitis and chronic diarrhea in univariate analysis and multivariate analysis.

Conclusion

The vagus nerve plays an imperative role in gastrointestinal motility, and hepatic and celiac branch preservation mainly exerts efficacy and safety in patients who undergo TLDG.

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Author notes

  1. Hao Xu, Linjun Wang, and Yawei Qian have contributed equally to this work.

Authors and Affiliations

  1. Division of Gastric Surgery, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People’s Republic of China

    Hao Xu, Linjun Wang, Yawei Qian, Zhongyuan He, Fengyuan Li, Weizhi Wang, Zheng Li, Qingya Li, Diancai Zhang, Li Yang & Zekuan Xu

  2. Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China

    Zekuan Xu

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  1. Hao Xu
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Contributions

ZKX and HX designed this study. LJW, YWQ, LY, and DCZ collected and analyzed the data. ZL, ZYH, and QYL were responsible for the follow-up of patients. YWQ and LJW participate in drafting the article. FYL and WZW revised the paper.

Corresponding author

Correspondence to Zekuan Xu.

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Disclosures

Drs. Hao Xu, Linjun Wang, Yawei Qian, Zhongyuan He, Fengyuan Li, Weizhi Wang, Zheng Li, Qingya Li, Diancai Zhang, Li Yang, and Zekuan Xu have no conflicts of interest or financial ties to disclose.

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Xu, H., Wang, L., Qian, Y. et al. Effectiveness of preserved vagal nerve in totally laparoscopy radical distal gastrectomy: a matched‐paired cohort analysis. Surg Endosc 37, 7538–7547 (2023). https://doi.org/10.1007/s00464-023-10254-z

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