Spade-Shaped Anastomosis after Laparoscopic Proximal Gastrectomy Using Double Suture Anchoring between the Posterior Wall of the Esophagus and the Anterior Wall of the Stomach (SPADE Operation): A Case Series

We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June 2017 and March 2020 were retrospectively reviewed. Reflux was evaluated based on the patients’ symptoms and follow-up endoscopy using Los Angeles (LA) classification and RGB Classification (Residue, Gastritis, Bile). Other complications were classified using the Clavien–Dindo method. The incidence of reflux esophagitis was 2.9% (1/34). Bile reflux was observed in six patients (17.6%), and residual food was observed in 16 patients (47.1%) in the endoscopy. Twenty-eight patients had no reflux symptoms (82.4%), while five patients (14.7%) and one patient (2.9%) had mild and moderate reflux symptoms, respectively. The rates of anastomotic stricture and ileus were 14.7% (5/34) and 11.8% (4/34), respectively. No anastomotic leakage was observed. The incidence of major complications (Clavien-Dindo grade III or higher) was 14.7%. The SPADE operation following laparoscopic PG is effective in reducing gastroesophageal reflux. Its clinical usefulness should be validated using prospective clinical trials.

Safety and Feasibility of Novel Reconstruction Method Using Long and Narrow Cobra- Head- Shaped Gastric Tube in Laparoscopic Proximal Gastrectomy for Cancer

Background. To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods, clinical outcomes of this LPG were evaluated and compared to those of LPG with our conventional method. Methods. Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side of the gastric tube created by linear stapler. Esophagogastrostomy is performed by direct anastomosis with overlap method between the posterior wall of the esophagus and anterior wall of the gastric tube using a linear stapler. In conventional method, direct anastomosis between the esophagus and a gastric tube by a circular stapler was performed. Short- and long-term outcomes of a novel method were compared with those of conventional method. Results. A total of 39 patients whom LPG was performed were enrolled in this retrospective study. The amount of blood loss in the Novel method group (n=30) was significantly less than those in the Conventional method group (n=9) (40 vs. 110 ml, p<0.01). No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis at 1 year after operation in the Novel group were less than those in the Conventional group (10% vs. 33%). In the Novel group, postoperative recurrence was observed in 2 patients (7%). Conclusions. LPG with novel reconstruction method using long and narrow cobra- head-shaped gastric tube can be easily performed, and may be feasible for the treatment of gastric cancer in the upper third of the stomach.

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

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.