Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

Abstract Proximal gastrectomy (PG) has been introduced for patients who are preoperatively diagnosed with early gastric cancer located in the upper third of the stomach. In the present study, we compared the prognosis of patients who underwent PG with that of patients who underwent total gastrectomy (TG). Between 1997 and 2006, 51 patients were diagnosed with early gastric cancer located in the upper third of the stomach and underwent PG. In the same period, 35 patients were diagnosed with early gastric cancer and underwent TG. Of these, in 24 patients, the cancer was localized in the middle to upper part of the stomach, and 11 patients had multiple cancers. We compared the clinicopathologic differences and prognoses between the two groups. Significantly fewer lymph nodes were dissected in the PG group (mean, 18.2) than in the TG group (mean, 36.6;P < 0.001). Complications were detected in 17.6% of patients in the PG group and in 14.3% of patients in the TG group, which was not significant (P = 0.678). The overall and disease-specific 5-year survival rates in the 51 patients who underwent PG (88.7% and 97.1%, respectively) were not different from those in the 35 patients who underwent TG (87.6% and 93.4%; P = 0.971 and P = 0.553; respectively). These findings indicate that PG can be performed safely and may have various advantages compared with TG in terms of patients' daily lives.

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

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.tps184 ◽

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.

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A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

10.21203/rs.2.11186/v1 ◽

2019 ◽

Author(s):

Shengnan Li ◽

Lihu Gu ◽

Zefeng Shen ◽

Danyi Mao ◽

Parikshit Asutosh Khadaroo ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Vitamin B12 ◽

Total Gastrectomy ◽

Reflux Esophagitis ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Cochrane Library ◽

Clinical Effects ◽

Double Tract Reconstruction

Abstract Background In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. Methods The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. Results The results showed no significant difference in the anastomotic stenosis (OR=0.91, 95%CI=0.33-2.50, p=0.85) and reflux esophagitis (OR=1.87, 95%CI=0.62-5.65, p=0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR=0.06, 95%Cl=0.01-0.59, p=0.02). Conclusions Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.

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A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

10.21203/rs.2.11186/v2 ◽

2019 ◽

Author(s):

Shengnan Li ◽

Lihu Gu ◽

Zefeng Shen ◽

Danyi Mao ◽

Parikshit Asutosh Khadaroo ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Vitamin B12 ◽

Total Gastrectomy ◽

Reflux Esophagitis ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Cochrane Library ◽

Clinical Effects ◽

Double Tract Reconstruction

Abstract Background In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. Methods The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. Results The results showed no significant difference in the anastomotic stenosis (OR=0.91, 95%CI=0.33-2.50, p=0.85) and reflux esophagitis (OR=1.87, 95%CI=0.62-5.65, p=0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR=0.06, 95%Cl=0.01-0.59, p=0.02). Conclusions Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.

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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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Clinical outcomes of gastric tube reconstruction following laparoscopic proximal gastrectomy for early gastric cancer in the upper third of the stomach: experience with 100 consecutive cases

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02132-w ◽

2021 ◽

Author(s):

Yoshitaka Toyomasu ◽

Erito Mochiki ◽

Toru Ishiguro ◽

Tetsuya Ito ◽

Okihide Suzuki ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Clinical Outcomes ◽

Gastric Tube ◽

Proximal Gastrectomy ◽

Laparoscopic Proximal Gastrectomy ◽

Upper Third ◽

Gastric Tube Reconstruction

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

Surgery ◽

10.1016/j.surg.2014.02.015 ◽

2014 ◽

Vol 156 (1) ◽

pp. 57-63 ◽

Cited By ~ 44

Author(s):

Masaki Nakamura ◽

Mikihito Nakamori ◽

Toshiyasu Ojima ◽

Masahiro Katsuda ◽

Takeshi Iida ◽

...

Keyword(s):

Gastric Cancer ◽

Early Gastric Cancer ◽

Proximal Gastrectomy ◽

Upper Third

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Proximal gastrectomy versus total gastrectomy for adenocarcinoma of the esophagogastric junction: a meta-analysis

Journal of Comparative Effectiveness Research ◽

10.2217/cer-2019-0016 ◽

2019 ◽

Vol 8 (10) ◽

pp. 753-766 ◽

Cited By ~ 1

Author(s):

Yi-chuan Chen ◽

Li Lu ◽

Kai-hu Fan ◽

Dao-han Wang ◽

Wei-hua Fu

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Survival Rate ◽

Total Gastrectomy ◽

Recurrence Rate ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Cochrane Library ◽

Overall Survival Rate ◽

Upper Third

Aim: To compare efficacy between total gastrectomy (TG) and proximal gastrectomy (PG) for upper-third gastric cancer. Materials & methods: PubMed, Embase and Cochrane library were searched to select suitable researches. Stata was used for meta-analysis including 5-year overall survival rate, recurrence rate, complication morbidities and serum nutritional levels. Results: Ten retrospective English researches were contained. Our study showed no significant difference of 5-year overall survival rate, recurrence rate, reflux symptoms and anastomotic leakage. TG experienced longer operation time, more lymph nodes-retrieved number, more estimated blood loss and higher ileus, but less anastomotic stricture. PG showed advantages over TG in terms of serum nutritional levels. Conclusion: PG is more preferable to TG for treatment of upper-third gastric cancer.

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