scholarly journals A Novel Method of Piggyback Jejunal Interposition Reconstruction Single-Tract Reconstruction After Proximal Gastrectomy for Siewert II and III Adenocarcinoma of the Esophagogastric Junction with a Diameter <4 cm

2021 ◽  
Author(s):  
Yuchao Ma ◽  
Jianhong Dong ◽  
Baoqing Ren ◽  
Wanhong Zhang ◽  
Liqiang Lei ◽  
...  
Keyword(s):  
Reflux Esophagitis ◽  
Complication Rate ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Jejunal Interposition ◽  
Reflux Symptoms ◽  
Postoperative Reflux ◽  
Novel Method ◽  
The Mean ◽  
Jejunal Interposition Reconstruction

Abstract Background Digestive tract reconstruction after proximal gastrectomy (PG) has been extensively discussed. Herein, we introduce a novel method of PG with piggyback jejunal interposition reconstruction single-tract reconstruction (PJIRSTR) for Siewert II and III adenocarcinoma of the esophagogastric junction (AEG) with a diameter <4 cm, and investigate its safety, practicability, and short-term and long-term clinical outcomes of this procedure. Method The clinical data of 33 patients with Siewert II or Siewert III AEG who underwent PJIRSTR in Shanxi Cancer Hospital from July 2013 to November 2016 were retrospectively reviewed. Data of clinicopathologic characteristics, postoperative and surgical outcomes, and follow-up findings, especially postoperative reflux esophagitis and postoperative reflux symptoms, were analyzed.Results The mean operation time was 136.7±22.4 (range: 110-180) min, including 32.3 ± 5.0(range: 26-45) min of the digestive tract reconstruction; the mean estimated blood loss was 87.6±18.1 mL; the mean number of dissected lymph nodes was 14.7±5.1; and the mean duration of postoperative hospitalization was 7.5±1.2 days. The early complication rate was 9% (n=3), including one case each of anastomotic bleeding, incision infection, and ileus. The late complication rate was 6% (n=2): both patients had gastroesophageal reflux symptoms (Visick grade II), but only one patient had Los Angeles grade B reflux esophagitis by endoscopy. Conclusion PJIRSTR is a safe, feasible, and innovative reconstruction method after PG for patients with Siewert II and III AEG with a diameter <4 cm. Furthermore, it has excellent efficiency in terms of preventing reflux symptoms and reflux esophagitis after surgery.

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

BMC Surgery ◽  
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.

scholarly journals Novel Reconstruction Using Roux-en-Y Plus Antral Obstruction Following Proximal Gastrectomy: Feasibility and Quality of Life Benefits

2019 ◽  
Author(s):  
Dejun Yang ◽  
Changming Wang ◽  
Hongbing Fu ◽  
Ziran Wei ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Partial Gastrectomy ◽  
Incidence Rates ◽  
Reconstruction Method ◽  
Reflux Symptoms ◽  
Reconstruction Methods ◽  
Postoperative Reflux

Abstract Background and Aims Routine gastroesophagostomy has been shown to have adverse effects on the recovery of digestive functions and quality of life because patients typically experience reflux symptoms after proximal gastrectomy. This study was performed to assess the feasibility and quality of life benefits of a novel reconstruction method termed Roux-en-Y anastomosis plus antral obstruction (RYAO) following proximal partial gastrectomy. Methods A total of 73 patients who underwent proximal gastrectomy from June 2015 to June 2017 were divided into two groups according to digestive reconstruction methods [RYAO (37 patients) and conventional esophagogastric anastomosis with pyloroplasty (EGPP, 36 patients)]. Clinical data were compared between the two groups retrospectively. Results The mean operative time for digestive reconstruction was slightly longer in the RYAO group than in the EGPP group. However, the incidence of postoperative short-term complications did not differ between the RYAO and the EGPP groups. At the 6-month follow-up, the incidence rates of both reflux esophagitis and gastritis were lower in the RYAO group than in the EGPP group (P = 0.002). Additionally, body weight recovery was better in the RYAO group (P = 0.028). The scale tests indicated that compared with the patients in the EGPP group, the patients in the RYAO group had significantly reduced reflux, nausea and vomiting and reported improvements in their overall health status and quality of life (all P < 0.05). Conclusion RYAO reconstruction may be a feasible procedure to reduce postoperative reflux symptoms and the incidence of reflux esophagitis and gastritis, thus improving patient quality of life after proximal gastrectomy.

scholarly journals Proximal Gastrectomy with Gastric Tube Reconstruction or Jejunal Interposition Reconstruction in the Upper Third Gastric Cancer: Which is Better for the Surgical Short-Term Outcomes.

2021 ◽  
Author(s):  
Zhiguo Li ◽  
Yan Ma ◽  
Guiting Liu ◽  
Ming Fang ◽  
YingWei Xue
Keyword(s):  
Gastric Cancer ◽  
Reflux Esophagitis ◽  
Gastric Tube ◽  
Proximal Gastrectomy ◽  
Jejunal Interposition ◽  
Short Term ◽  
Significant Difference ◽  
Jejunal Interposition Reconstruction ◽  
Upper Third ◽  
Gastric Tube Reconstruction

Abstract Objective: Proximal gastrectomy was acted as a function-preserving operation for upper third gastric cancer. The aim of this study is to compare the surgical short-term outcomes between proximal gastrectomy with gastric tube reconstruction and proximal gastrectomy with Jejunal interposition reconstruction in the upper third gastric cancer. Methods: A retrospective review of 301 patients who underwent proximal gastrectomy with jejunal interposition (JI) or gastric tube (GT) at the 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 the post-gastrectomy syndromes. The gastrointestinal fiberoscopy was used to evaluate the prevalence and severity of reflux esophagitis by Los Angeles (LA) classification system. Results: The JI group had a longer operation time than GT group (220±52 vs 182±50 min), whereas there was no significant difference in blood loss. Compared to the GT group, the Visick grade and GSRS score were significantly higher than that of the JI group. The reflux esophagitis of GT group was significantly higher than that of the JI group. Conclusion: Proximal gastrectomy is well tolerated, with excellent short-outcomes in patients with upper third gastric cancer . C ompared with GT construction, JI construction has clear functional advantages and may provide better quality of life for patients with upper third gastric cancer.

Proximal Gastric Resection with Posterior Esophago-Gastrostomy and Partial Neo-Fundoplication in the Treatment of Advanced Upper Gastric Carcinoma

2019 ◽  
Vol 37 (2) ◽  
pp. 119-128 ◽  
Author(s):  
Wojciech P. Polkowski ◽  
Jerzy Mielko ◽  
Katarzyna Gęca ◽  
Karol Rawicz-Pruszyński ◽  
Bogumiła Ciseł ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Gastric Resection ◽  
Proximal Gastrectomy ◽  
Hospital Death ◽  
Reflux Symptoms ◽  
Postoperative Reflux ◽  
Circulatory Insufficiency ◽  
The Mean ◽  
Neo Adjuvant Chemotherapy

Background: Proximal gastric resection (PGR) is rarely used in western countries because of frequent postoperative reflux and uncommon diagnosis of early gastric cancer (GC). Objectives: We hypothesized that the PGR with an anti-reflux procedure may be an attractive option even in advanced proximal GC after downstaging with the neo-adjuvant chemotherapy. Method: A novel technique of end-to-side esophago-gastrostomy with the posterior wall of the gastric stump and partial neo-fundoplication to prevent reflux symptoms has been introduced. An observational retrospective study was undertaken to evaluate early and late outcomes of the innovative technique in patients with advanced proximal GC after neoadjuvant chemotherapy. Results: Twenty consecutive patients with the diagnosis of loco-regionally advanced GC, localized in the subcardiac region or proximal upper third of the stomach, were selected for the study. Eleven (55%) patients completed preoperative neo-adjuvant chemotherapy. The mean postoperative hospitalization time was 13.3 (± 8.3) days. There was one postoperative in-hospital death due to acute circulatory insufficiency. The mean comprehensive complication index was 11.94 (±24.82). Two patients were diagnosed with a complete pathological response (ypT0N0). Median survival was 41.8 (95% CI 27.9–41.8) months. The 5-year survival rate was 42%. At a median follow-up of 26 months, reflux symptoms were present in 7 (35%) patients who had to use antireflux medication. Anastomotic stenosis was observed in 1 patient during the follow-up. Mean scores of reflux symptoms on medication were not significantly different to those in patients without medication. The Overall Satisfaction Score for patients on medication was 7.57 ± 1.92, whereas it was 8.83 ± 1.34 (p = 0.2; Student t test) for those with no medication. Conclusions: Proximal gastrectomy is feasible and may be safely used in patients with advanced GC after neo-adjuvant chemotherapy with acceptable survival. Posterior esophago-gastrostomy with partial neo-fundoplication reduces the postoperative reflux, while patients with persistent reflux symptoms can be effectively treated with an antireflux therapy.

scholarly journals Comparative analysis of laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis with laparoscopic total gastrectomy for adenocarcinoma of the esophagogastric junction: a single-center retrospective cohort study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yupeng Wu ◽  
Shihao Zhang ◽  
Liting Wang ◽  
Xuya Hu ◽  
Zhanxue Zhang
Keyword(s):  
Weight Loss ◽  
Total Gastrectomy ◽  
Reflux Esophagitis ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Laparoscopic Total Gastrectomy ◽  
Reconstruction Method ◽  
Postoperative Reflux ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy

Abstract Background We invented a new antireflux anastomosis method for use in proximal gastrectomy for adenocarcinoma of the esophagogastric junction (AEG) and named it semi-embedded valve anastomosis (SEV). This study was conducted to compare and analyze the short-term efficacy and long-term prognosis of this anastomosis reconstruction method versus laparoscopic total gastrectomy (LTG). Methods We retrospectively analyzed the general data and surgical outcomes of patients with AEG who underwent three united laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis (TULPG-SEV, N = 20) and LTG (N = 20) at our hospital from January 2015 to September 2017 and investigated the incidence of postoperative reflux esophagitis and postoperative nutritional status between the two groups. Survival analysis was also performed. Results The operative time (178.25 ± 15.41 vs 196.5 ± 21.16 min) and the gastrointestinal reconstruction time (19.3 ± 2.53 vs 34.65 ± 4.88 min) of the TULPG-SEV group were significantly less than that of the LTG group. There was no difference in intraoperative blood loss, length of hospital stay, and postoperative complications. There was no difference in the scores on the postoperative reflux disease questionnaires (RDQs) conducted 1 month (P = 0.501), 3 months (P = 0.238), and 6 months (P = 0.655) after surgery between the TULPG-SEV group and LTG group. Gastroscopy revealed 2 cases of reflux esophagitis (grade B or higher) in each group. The postoperative hemoglobin level was better in the TULPG-SEV group than in the LTG group, and the difference was most noticeable at 1 month after surgery (P = 0.024) and 3 months after surgery (P = 0.029). The levels of albumin and total protein were not significantly different between the groups. There were more patients with weight loss over 5 kg after surgery in the LTG group than in the TULPG-SEV group (P = 0.043). There was no significant difference in the 3-year overall survival rate between the two groups (P = 0.356). Conclusion SEV has a certain antireflux effect and can reduce the anastomosis time. Proximal gastrectomy may be better than total gastrectomy for maintaining postoperative hemoglobin levels and reducing weight loss.

scholarly journals Proximal Gastrectomy with Anti-reflux Anastomosis for Patients with Adenocarcinoma of Esophagogastric Junction: A Simple and Safe Triangle-Valve Technique

2020 ◽  
Author(s):  
Yongshun Gao ◽  
Jiangang Sun ◽  
Yuheng Chen ◽  
Yunfei Zhang ◽  
Peng Chen ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Reflux Disease ◽  
Total Protein ◽  
Esophagogastric Junction ◽  
Proximal Gastrectomy ◽  
Operating Time ◽  
Operation Time ◽  
Post Surgery ◽  
Surgical Methods ◽  
The Mean

Abstract Background A simple and safe triangle-valve technique (TVT) was applied to proximal gastrectomy (PG) in order to prevent post-surgery gastric reflux among patients with adenocarcinoma of the esophagogastric junction (AEG). Its clinical outcomes were evaluated in comparison to those of the canonical total gastrectomy (TG). Method This retrospective study of 74 AEG patients compared two surgical procedures PG-TVT (n = 44) and TG (n = 30) in terms of their surgical outcomes, postoperative complications, and nutritional status. All patients were followed-up for 6 months. Reflux Disease Questionnaire (RDQ) was used to evaluate reflux esophagitis. patients with the RDQ score of ≥12 points were diagnosed with gastroesophageal reflux disease (GERD). Results The mean operation time was significantly shorter in PG-TVT group (242.6 minutes) than in TG group (288.1 minutes). The overall postoperative complication rate was not significantly different between PG-TVT and TG groups. All patients were followed up by 6 months. None of them developed cancer recurrence in distant organs, remnant stomach, or lymph nodes. The GERD incidence was similar between PG-TVT and TG groups. The mean levels of total protein and albumin within the 6 months were significantly higher in PG-TVT group than in TG group after adjusting the time effect and the interaction of time and surgical methods. The level of total protein significantly increased within 6 months in PG-TVT but decreased in TG group. Conclusion PG-TVT provides several advantages including a shorter operating time, better postoperative nutritional status, and similar incidence of GERD over TG for AEG patients.

Endoscopic Evaluation of Reflux Esophagitis After Proximal Gastrectomy: Comparison Between Esophagogastric Anastomosis and Jejunal Interposition

2008 ◽  
Vol 32 (7) ◽  
pp. 1473-1477 ◽  
Author(s):  
Masanori Tokunaga ◽  
Shigekazu Ohyama ◽  
Naoki Hiki ◽  
Etsuo Hoshino ◽  
Souya Nunobe ◽  
...  
Keyword(s):  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Jejunal Interposition ◽  
Esophagogastric Anastomosis ◽  
Endoscopic Evaluation

scholarly journals Feasibility of Laparoscopic Proximal Gastrectomy With Piggyback Jejunal Interposition Double-Tract Reconstruction for Proximal Gastric Cancer. A Propensity Score Matching Analysis

2021 ◽  
Author(s):  
ZhiGuo Li ◽  
JianHong Dong ◽  
QingXing Huang ◽  
Wei Guo ◽  
YanYang Song ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Reflux Esophagitis ◽  
Proximal Gastrectomy ◽  
Jejunal Interposition ◽  
Double Tract Reconstruction ◽  
Laparoscopic Proximal Gastrectomy ◽  
One Year ◽  
Better Than

Abstract Background The clinical effect of laparoscopic proximal gastrectomy (LPG) with piggyback jejunal interposition double-tract reconstruction (PJIDTR) is not clear yet. The purpose of this study was to compare the efficacy of LPG with PJIDTR versus laparoscopic total gastrectomy (LTG) with Roux-en-Y reconstruction (overlap method) for proximal EGC using propensity score matching. Methods We retrospectively collected data from the patients with proximal EGC who were treated in Shanxi Cancer Hospital between January 2012 and December 2015. Propensity score was used to match LTG patients with LPG patients. The patient characteristics, clinical outcomes, nutritional indicators, reflux esophagitis incidence and overall survival were compared between the two groups. Results Of the 424 patients, 200 were excluded and 50 of the remaining patients received LPG with PJIDTR. Fifty matched LTG patients were screened. Comparison of intraoperative indicators, operative time, blood loss and number of retrieved lymphnodes between the two groups showed no statistical significance (P > 0.05). There was no statistically significant differences in first anal exhaust time, postoperative hospital stay, and early complications between the two groups (P > 0.05). The nutrition indexes at one year after surgery in the LPG group were significantly better than LTG group (P < 0.05). At one year, there were no differences in reflux symptoms (Visick score) or endoscopic esophagitis (Los Angeles Classification) between the two groups. No tumor recurrence was observed in either group. The 5-year overall survival rates of the two groups were 98% and 90%, respectively (p = 0.08). Conclusion The postoperative nutritional outcomes of LPG with PJIDTR were better than those of LTG. The incidence of reflux esophagitis, complications, and 5-year overall survival were similar between the two groups. LPG with PJIDTR may be suitable for proximal EGC.

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