A novel method for π-shaped esophagojejunostomy and double-tract reconstruction (DTR) as an alternative in totally laparoscopic or robotic proximal gastrectomy for treating upper third proximal early gastric cancer

2021 ◽  
Vol 73 (2) ◽  
pp. 597-605
Author(s):  
Shangxin Zhang ◽  
Deguan Li ◽  
Yigao Wang ◽  
Xiaodong Yang ◽  
Zhen Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Double Tract Reconstruction ◽  
Novel Method ◽  
Totally Laparoscopic ◽  
Upper Third

Multicenter prospective randomized controlled trial of comparing laparoscopic proximal gastrectomy and laparoscopic total gastrectomy for upper third early gastric cancer (KLASS-05).

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. TPS184-TPS184
Author(s):  
Do Joong Park ◽  
Hyung-Ho Kim ◽  
Sang Uk Han ◽  
Woo Jin Hyung ◽  
Sun-Hwi Hwang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Randomized Controlled Trial ◽  
Early Gastric Cancer ◽  
Controlled Trial ◽  
Proximal Gastrectomy ◽  
Randomized Controlled ◽  
Double Tract Reconstruction ◽  
Postoperative Reflux ◽  
Prospective Randomized Controlled Trial ◽  
Upper Third

TPS184 Background: Proximal gastrectomy (PG) is rarely performed for upper third early gastric cancer (EGC) because of postoperative reflux esophagitis. Recently, PG with double tract reconstruction was introduced and reported to have a reflux of approximately the same frequency as total gastrectomy (TG) with esophagojejunostomy. PG has several theoretical advantages over TG but has not yet been proven in randomized controlled trial. This study aimed to provide scientific evidence of laparoscopic PG with double tract reconstruction as a standard procedure for proximal EGC. Methods: The present trial is multicenter, prospective, randomized, controlled trial with superiority design. A total of 138 patients with upper third cT1N0M0 gastric adenocarcinoma are randomized to laparoscopic PG with double tract reconstruction and laparoscopic TG with esophagojejunostomy. Patients are enrolled for two years and followed up for two years. Primary co-endpoints are hemoglobin change and vitamin B12 cumulative supplement quantity after 2 years of operation. We used the alpha-split method to set the hemoglobin to 4% and vitamin B12 to 1% for alpha. The sample size needed was 62 patients for each arm. Accounting for 10% follow-up loss, the enrollment of 69 patients in each group was required. Secondary endpoints are prevalence rate of postoperative reflux esophagitis, morbidity and mortality, quality of life 2-year after operations, relapse-free survival, and overall survival. Nineteen investigators from 10 institutes participated in this trial. The first patient was enrolled on October 27, 2016 and we completed the patient enrollment on September 17, 2018. Clinical trial information: NCT02892643.

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

BMC Surgery ◽  
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.

scholarly journals Single-Port Laparoscopic Proximal Gastrectomy with Double Tract Reconstruction for Early Gastric Cancer: Report of a Case

2016 ◽  
Vol 16 (3) ◽  
pp. 200 ◽  
Author(s):  
Chang Min Lee ◽  
Da Won Park ◽  
Do Hyun Jung ◽  
You Jin Jang ◽  
Jong-Han Kim ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Single Port ◽  
Proximal Gastrectomy ◽  
Double Tract Reconstruction ◽  
Laparoscopic Proximal Gastrectomy

Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: An analysis of our 13-year experience

Surgery ◽  
2014 ◽  
Vol 156 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Masaki Nakamura ◽  
Mikihito Nakamori ◽  
Toshiyasu Ojima ◽  
Masahiro Katsuda ◽  
Takeshi Iida ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Upper Third

Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach

2003 ◽  
Vol 90 (7) ◽  
pp. 850-853 ◽  
Author(s):  
H. Katai ◽  
T. Sano ◽  
T. Fukagawa ◽  
H. Shinohara ◽  
M. Sasako
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Prospective Study ◽  
Proximal Gastrectomy ◽  
Upper Third

scholarly journals A Case of Laparoscopic Resection for Carcinoma of the Gastric Remnant following Proximal Gastrectomy Reconstructed with Jejunal Interposition

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kazuhito Yajima ◽  
Yoshiaki Iwasaki ◽  
Ken Yuu ◽  
Ryouki Oohinata ◽  
Misato Amaki ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Early Stage ◽  
Proximal Gastrectomy ◽  
Laparoscopic Approach ◽  
Jejunal Interposition ◽  
Gastric Remnant ◽  
Successful Case ◽  
Old Japanese ◽  
Upper Third

A 72-year-old Japanese man had a history of proximal gastrectomy for early gastric cancer located in the upper third of the stomach in 2007. Our usual treatment strategy for early gastric cancer in the upper third of the stomach in 2007 was open proximal gastrectomy reconstructing by jejunal interposition with a 10 cm single loop. Upper gastrointestinal fiberscopy for annual follow-up revealed a type 0-IIc-shaped tumor with ulcer scar, 4.0 cm in size, located in the gastric remnant near the jejunogastrostomy. A clinical diagnosis of cancer of the gastric remnant, clinical T1b(SM)N0M0, Stage IA, following the proximal gastrectomy was made and a laparoscopic approach was selected because of the cancer’s early stage. Remnant total gastrectomy with D1 plus lymphadenectomy was carried out with five ports by a pneumoperitoneal method. Complete resection of the reconstructed jejunum was undergone along with the jejunal mesentery. Reconstruction by the Roux-en-Y method via the antecolic route was selected. Total operative time was 395 min and blood loss was 40 mL. Our patient was the first successful case of resection for carcinoma of the gastric remnant following proximal gastrectomy reconstructed with jejunal interposition in a laparoscopic approach.

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