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

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.

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

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.

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.

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.