A newly modified esophagogastrostomy with a reliable angle of His by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy

Yasuda, Atsushi; Yasuda, Takushi; Imamoto, Haruhiko; Katô, Hiroaki; Nishiki, Kohei; Iwama, Mitsuru; Makino, Tomoki; Shiraishi, Osamu; Shinkai, Masayuki; Imano, Motohiro; Furukawa, Hiroshi; Okuno, Kiyokata; Shiozaki, Hitoshi

doi:10.1007/s10120-014-0431-6

Cited by 38 publications

(48 citation statements)

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“…Postoperative anastomotic stricture is another possible complication of proximal gastrectomy, especially after oesophagogastrostomy. Oesophagogastric anastomotic stricture occurred in 8 per cent of the patients, a lower rate than that reported in most other studies (range 8·2–28·0 per cent).…”

Section: Discussioncontrasting

confidence: 57%

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Laparoscopic proximal gastrectomy with double-flap technique versus laparoscopic subtotal gastrectomy for proximal early gastric cancer

et al. 2019

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Background Laparoscopic proximal gastrectomy with double‐flap technique (LPG‐DFT) and laparoscopic subtotal gastrectomy (LSTG) may replace laparoscopic total gastrectomy (LTG) for proximal early gastric cancer. The aim of this study was to evaluate short‐ and long‐term outcomes after LPG‐DFT and LSTG. Methods Patients who underwent LPG‐DFT or LSTG at the Cancer Institute Hospital in Tokyo between January 2006 and April 2015 were included in this retrospective study. Operative procedures were selected based on the distance from the cardia to the proximal boundary of the tumour, tumour location and predicted remnant stomach volume. Patient characteristics, surgical data, markers of postoperative nutritional status, such as blood chemistry and bodyweight loss, and endoscopic findings were compared between procedures. The main study outcome was nutritional status. Results A total of 161 patients (LPG‐DFT 51, LSTG 110) were included. Types of postoperative complication occurring more than 30 days after surgery differed between the two procedures. Remnant stomach ulcers, including anastomotic ulcers, were observed only after LPG‐DFT, whereas complications involving the small intestine, such as internal hernia or small bowel obstruction, occurred more frequently after LSTG. Values for total protein, albumin, prealbumin and bodyweight loss were comparable between the two procedures at 36 months after surgery. Haemoglobin concentrations were higher after LPG‐DFT than after LSTG at 24 months (13·4 versus 12·8 g/dl respectively; P = 0·045) and 36 months (13·5 versus 12·8 g/dl; P = 0·007) after surgery. The rate of Los Angeles grade B or more severe reflux oesophagitis was comparable. Conclusion LPG‐DFT and LSTG for proximal early gastric cancer have similar outcomes, but different types of complication.

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Section: Discussioncontrasting

confidence: 57%

“…Surgical outcomes of LPG may depend on the type of reconstruction, as reflux oesophagitis is one of the most important determinants of long‐term outcome. The size of the remnant stomach may influence other long‐term outcomes, such as haemoglobin concentration.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic proximal gastrectomy with double-flap technique versus laparoscopic subtotal gastrectomy for proximal early gastric cancer

et al. 2019

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“…Simple EG without any additional antireflux procedure has been reported to cause reflux esophagitis in 9.1%‐35.3% of patients, and even JI, JPI and DT, which are supposed to prevent the occurrence of reflux, resulted in reflux esophagitis in 0%‐15.8%, 8.3%‐15.8% and 0%‐25% of cases, respectively, which are not negligible incidences . Some EG with additional antireflux procedures, such as fundoplication, successfully reduced the incidence of reflux esophagitis to below 10%, whereas other EG failed to prevent the occurrence of reflux even with additional antireflux procedures, resulting in reflux esophagitis in over 30% of cases . Previous DFT reports that included a variety of cases (n = 112) showed that DFT successfully prevented the occurrence of reflux esophagitis (≥grade B) with an incidence of 2.7% (3/112) .…”

Section: Discussionmentioning

confidence: 99%

Multicenter retrospective study to evaluate the efficacy and safety of the double‐flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD‐FLAP Study)

Kuroda

Choda

Otsuka

et al. 2018

Annals of Gastroent Surgery

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AimAs a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double‐flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single‐center studies with a limited number of cases.MethodsWe conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1‐year after surgery, and secondary endpoint was incidence of anastomosis‐related complications.ResultsOf 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1‐year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra‐thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44‐10.9, P = 0.0109). Total incidence of anastomosis‐related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis‐related complications (OR: 3.93, 95% CI: 1.93‐7.80, P = 0.0003).ConclusionDouble‐flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well‐prepared for.

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“…The reasons why on -third of patients with a T1 U tumor received total gastrectomy in our institute may be related to this problem. Recently, we and others developed novel methods for modified esophagogastrostomy by creating a reliable angle of His using a stapler [26,27]. These techniques may become a feasible choice for simple reconstruction after proximal gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

et al. 2016

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Background Proximal gastrectomy has been introduced for early gastric cancer located in the upper third of the stomach, but expansion of its indication to advanced tumors has not been generally accepted in terms of lesser curvature lymph node dissection. Methods We reviewed the medical records of 385 patients with tumors in the upper third of the stomach, and the incidence of metastasis and the therapeutic index related to the proximal (no. 3a) and distal (no. 3b) lymph nodes of the lesser curvature were analyzed and compared with those of tumors in the middle third (n = 1093) and lower third (n = 922) of the stomach. Results The no. 3a rate of metastasis from advanced tumors in the upper third of the stomach was significantly higher than that from tumors in the middle third or lower third of the stomach. The no. 3b metastasis rate did not show any significant differences between the three locations, but the therapeutic index of no. 3b lymph nodes in the upper third of the stomach (1.7) was far lower than that in the middle third (7.1) or lower third (7.0). Further, the rate of metastasis from tumors with the distal border ending in the upper third of the stomach (2.2 %) was significantly (P \ 0.0001) lower than that from tumors located in the upper third of the stomach but extending to the middle third (19.6 %), as well as from tumors located in middle third (17.1 %) or lower third (19.6 %), with the therapeutic index being only 1.1. The four no.-3b-positive tumors all measured more than 40 mm, and included one T3 tumor and three T4 tumors. Conclusion Proximal gastrectomy with exclusion of no. 3b lymphadenectomy could be indicated for at least T2 tumors measuring less than 40 mm localized in the upper third of the stomach.

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A newly modified esophagogastrostomy with a reliable angle of His by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy

Cited by 38 publications

References 20 publications

Laparoscopic proximal gastrectomy with double-flap technique versus laparoscopic subtotal gastrectomy for proximal early gastric cancer

Laparoscopic proximal gastrectomy with double-flap technique versus laparoscopic subtotal gastrectomy for proximal early gastric cancer

Multicenter retrospective study to evaluate the efficacy and safety of the double‐flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD‐FLAP Study)

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

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