Surgical techniques to prevent reflux esophagitis in proximal gastrectomy reconstructed by esophagogastrostomy with preservation of the lower esophageal sphincter, pyloric and celiac branches of the vagal nerve, and reconstruction of the new His angle for early proximal gastric cancer

Abstract To clarify the significance of the lower esophageal sphincter (LES) for prevention of alkaline reflux esophagitis (ARE) after total gastrectomy reconstructed by Roux-en-Y (TGRY) for gastric cancer, we investigated LES function and lower esophageal pH in TGRY patients with or without LES preservation. A total of 51 patients 5 years after TGRY were divided into groups A (26 patients without preserved LES) and B (25 patients with preserved LES) and compared with 22 control participants (group C). Manometric study and ambulatory 24-hour esophageal pH monitoring were performed on all patients. Symptomatic and endoscopic AREs in group A were significantly higher than those in group B (P < 0.05). The length of LES and maximum LES pressure in group A were significantly shorter and lower, respectively, than in groups B and C (P < 0.01). The length of LES and maximum LES pressure in patients with symptomatic ARE were significantly shorter and lower, respectively, than in patients without symptomatic ARE (P < 0.01). Percentages of time with pH >7 and pH >8 within 24 hours in group A were significantly higher than those in groups B and C (P < 0.01). Preservation of the LES may be necessary to prevent ARE after TGRY.

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Operative Technique on Nearly Total Gastrectomy Reconstructed by Interposition of a Jejunal J pouch with Preservation of Vagal Nerve, Lower Esophageal Sphincter, and Pyloric Sphincter for Early Gastric Cancer

World Journal of Surgery ◽

10.1007/s00268-001-0163-8 ◽

2001 ◽

Vol 25 (12) ◽

pp. 1524-1531 ◽

Cited By ~ 13

Author(s):

Ryouichi Tomita ◽

Shigeru Fujisaki ◽

Katsuhisa Tanjoh ◽

Masahiro Fukuzawa

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Total Gastrectomy ◽

Lower Esophageal Sphincter ◽

Operative Technique ◽

Vagal Nerve ◽

Pyloric Sphincter ◽

J Pouch ◽

Esophageal Sphincter

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Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

Frontiers in Oncology ◽

10.3389/fonc.2020.607922 ◽

2021 ◽

Vol 10 ◽

Author(s):

Peirong Tian ◽

Yang Liu ◽

Shibo Bian ◽

Mengyi Li ◽

Meng Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Lymph Nodes ◽

Total Gastrectomy ◽

Reflux Esophagitis ◽

Proximal Gastrectomy ◽

Laparoscopic Total Gastrectomy ◽

Anastomotic Stenosis ◽

Proximal Gastric Cancer ◽

Laparoscopic Proximal Gastrectomy

BackgroundTo compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer.MethodsOriginal English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer).ResultsFourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = −13.33, 95% CI: −15.66 to −11.00, P < 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = −42.51, 95% CI: −58.99 to −26.03, P < 0.00001), less intraoperative blood loss (WMD = −79.52, 95% CI: −116.63 to −42.41, P < 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG.ConclusionLPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.

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Proximal gastrectomy with gastric tube reconstruction or jejunal interposition reconstruction in upper-third gastric cancer: which offers better short-term surgical outcomes?

BMC Surgery ◽

10.1186/s12893-021-01239-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhiguo Li ◽

Yan Ma ◽

Guiting Liu ◽

Ming Fang ◽

Yingwei Xue

Keyword(s):

Gastric Cancer ◽

Reflux Esophagitis ◽

Surgical Outcomes ◽

Gastric Tube ◽

Proximal Gastrectomy ◽

Jejunal Interposition ◽

Short Term ◽

Jejunal Interposition Reconstruction ◽

Upper Third ◽

Gastric Tube Reconstruction

Abstract Objective Proximal gastrectomy acts as a function-preserving operation for upper-third gastric cancer. The aim of this study was to compare the short-term surgical outcomes between proximal gastrectomy with gastric tube reconstruction and proximal gastrectomy with jejunal interposition reconstruction in upper-third gastric cancer. Methods A retrospective review of 301 patients who underwent proximal gastrectomy with jejunal interposition (JI) or gastric tube (GT) at Harbin Medical University Cancer Hospital between June 2007 and December 2016 was performed. The Gastrointestinal Symptom Rating Scale (GSRS) and Visick grade were used to evaluate postgastrectomy syndromes. Gastrointestinal fiberoscopy was used to evaluate the prevalence and severity of reflux esophagitis based on the Los Angeles (LA) classification system. Results The JI group had a longer operation time than the GT group (220 ± 52 vs 182 ± 50 min), but no significant difference in blood loss was noted. Compared to the GT group, the Visick grade and GSRS score were significantly higher. Reflux esophagitis was significantly increased in the GT group compared with the JI group. Conclusion Proximal gastrectomy is well tolerated with excellent short-term outcomes in patients with upper-third gastric cancer. Compared with GT construction, JI construction has clear functional advantages and may provide better quality of life for patients with upper-third gastric cancer.

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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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