Double tract reconstruction versus double flap technique: short-term clinical outcomes after laparoscopic proximal gastrectomy for early gastric cancer

Background: Laparoscopic proximal gastrectomy with an anti-reflux procedure, as a function-preserving surgery, has been a common treatment strategy for proximal early gastric cancer. This study aimed to develop a new surgical technique for these patients. Methods: Laparoscopic proximal gastrectomy with vagus nerve preservation and double-flap technique was performed in patients who could retain two-thirds of the stomach. The hepatic branches and the celiac branches were both preserved. A seromuscular double-flap was created through the auxiliary incision, and the anastomosis was performed under laparoscopy. The detailed surgical procedure and preliminary results were presented. Results: Six patients underwent this procedure with no conversion to open surgery. No intraoperative and postoperative complications occurred during the perioperative period. No patients showed diarrhea and appetite loss, and body weight regained preoperative level 6 month later. No food residue and reflux esophagitis were observed via endoscopic examination. Gallbladder contraction was observed in all the patients by ultrasonography after high-fat diet. Conclusion: Although long-term follow up and a larger number of patients are required to evaluate the functional outcomes, this new technique provides a minimally invasive surgical option for proximal early gastric cancer, especially in the cardiac area.

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Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer

Surgical Endoscopy ◽

10.1007/s00464-017-5429-9 ◽

2017 ◽

Vol 31 (10) ◽

pp. 3961-3969 ◽

Cited By ~ 30

Author(s):

Do Hyun Jung ◽

Yoontaek Lee ◽

Dong Wook Kim ◽

Young Suk Park ◽

Sang-Hoon Ahn ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Total Gastrectomy ◽

Proximal Gastrectomy ◽

Laparoscopic Total Gastrectomy ◽

Double Tract Reconstruction ◽

Laparoscopic Proximal Gastrectomy

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Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

BMC Surgery ◽

10.1186/s12893-021-01153-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shuo-meng Xiao ◽

Ping Zhao ◽

Zhi Ding ◽

Rui Xu ◽

Chao Yang ◽

...

Keyword(s):

Gastric Cancer ◽

Proximal Gastrectomy ◽

Operation Time ◽

Nutrition Status ◽

Proximal Gastric Cancer ◽

Double Tract Reconstruction ◽

Significant Difference ◽

Laparoscopic Proximal Gastrectomy ◽

Gastric Cancer Patients ◽

Upper Third

Abstract Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

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