The study "Physiologic vs. Non-Physiologic Anastomosis after Subtotal Gastrectomies for Gastric Cancer" analyzes postoperative outcomes in gastric cancer patients undergoing subtotal gastrectomy with different anastomotic techniques. The research compares morbidity, mortality, recurrence rates, and quality of life using statistical evaluation. Findings indicate that physiologic anastomoses result in lower complications and better postoperative recovery, while non-physiologic anastomoses may reduce reflux esophagitis rates but show higher recurrence and mortality.

1. PHYSIOLOGIC VS NON-PHYSIOLOGIC
ANASTOMOSIS AFTER SUBTOTAL
GASTRECTOMIES FOR GASTRIC CANCER
C. COSMA, C.NICOLESCU, C.RUSSU, V.BUTIURCĂ, C.MOLNAR
General Surgery I - Emergency County Hospital - Tg.Mures Romania
University of Medicine, Pharmacy, Science and Technology-Tg.Mureș

8. • BACKSECTIVE study
• 3 years 2019-2021
• Cases of gastric neoplasms treated medico-surgically (subtotal
gastrectomies) with physiologic/non-physiologic anastomoses -
Surgery 1 -SCJU Tg.Mures
We used the Student test to assess the differences between means of continuous variables in two groups. For categorical variables, a χ2 test
(expressed as no (%) was used. Differences between non-parametric variables (expressed as median, range) were compared using the Mann-
Whitney U test and the Kruskal Wallis test, respectively. All our tests performed at significance p = 0.05 and statistical significance was
considered for p-values less than the significance threshold value.
The study was conducted in accordance with the Declaration of Helsinki (1964) and was approved by the Ethics Committee of the County
Emergency Hospital of Targu Mures. All patients were included in this study with informed consent. They fulfilled all EU professional ethics
requirements, the identity of the patients being confidential.

9. Overview
72% male
0 20 40 60 80 100
20-29
30-39
40-49
50-59
60-69
70-79
80+
82 cases
38 physiological
50 non-physiological
0 5 10 15 20 25 30 35 40
1
Hospitalization
Average: 20 days
Hospitalization
Max: 35 days
Min : 8 day

10. TNM AJCC 7th Ed.
TNM P value
T0 - - -
Tis - - -
T1 a/b - - -
T2 13 13 0.411
T3 25 35 0.171
T4 a/b 1 2 0.254
N0 8 7 0.345
N1 28 35 0.245
N2 2 8 0.090
N3 a/b 0 1 0.567
M0 37 49 0.452
M1 1 2 0.254

11. Postoperative complications
Complications P value
Gastro-
duodenal/gastro-jejunal
anastomotic fistulas
2 6 0.001
Bleeding 2 2 0.089
Abcese-Sepsis 2 1 0.345
Prolonged
postoperative ileus
1 2 0.456
Wound oozing 2 3 0.234
Seroame 1 2 0.421
Recurrence
2.5% -
PHYSIOLOGICAL
8% -NON-
PHYSIOLOGICAL
p=0,0033
80% re-intervention
rate
Mortality
8% NON-PHYSICAL
4%-PHYSIOLOGICAL

12. Histopathology
Histopathologic subtype P value
Tubular adenocarcinoma 14 18 0.431
Mucinous
adenocarcinoma
9 12 0.241
Papillary adenocarcinoma 15 20 0.331

13. Digestive endoscopy
postoperative control
Los
Angeles
Grading
P value
A 10 4 0,001
B 6 2 0,003
C 2 2 0,452
D - - -

14. 1.80 1.95
1.70
3.40
5.30
4.80 4.90
4.50
0.00
1.00
2.00
3.00
4.00
5.00
6.00
1 2 3 4 5 6 7 8
ALBUMIN G/DL
Albumin g/dL
9100
6200
7900
6500
4200
3200
2200
1300 1000
1 2 3 4 5 6 7 8 9
Axis
Title
Axis Title
Lymphocyte
190 180 190
210 220
180 190
170
1 2 3 4 5 6 7 8
TOTAL CHOLESTEROL
Total Cholesterol
P =0,031

15. P =0,001

16. Conclusions
• In the case of physiologic anastomoses, the morbidity and mortality rate is
lower with better postoperative recovery of patients.
• Reflux esophagitis occurs less frequently in non-physiologic reconstructions.
• Physiologic anastomoses - Gastrectomy quality of life index ,CONUT score
showed a better recovery of patients for socio-economic reintegration

17. Bibliography
• Dos Santos Gabriel Dos Santos1, Voliovici Eduardo2 and Olivera
Pertusso Eduardo3* Cholecystitis and Synchronous Liver Abscess:
Percutaneous Treatment Results Acta Scientific Gastrointestinal
Disorders(ISSN: 2582-1091)Volume 2 Issue 9 November 2019
• F. Aguilar-Espinosa, R. Maza-Sánchez, F. Vargas-Solís, G.A. Guerrero-
Martínez, J.L. Medina-Reyes, P.I. F lores-Quiroz Cholecystoduodenal
fistula, an infrequent complication of cholelithiasis: Our experience
in its surgical management Revista de Gastroenterología de México.
2017;82(4):287---295
• K. M. STAMOU, P. B. KEKIS & M. GLYNATSIS 1st Department of
Propaedeutic Surgery, Hippokrateion Hospital, Athens, Greece
Gallbladder-duodenal fistula presenting with liver abscess and
upper gastrointestinal bleeding HPB, 2006; 8: 69/70

18. Thank you!