Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition

Abstract

BackgroundFor early gastric cancer located in the upper third of the stomach, we have adopted laparoscopic 1/2-proximal gastrectomy (PG) with two types of reconstruction: double tract reconstruction (L-DT) and jejunal interposition reconstruction with crimping of the jejunum on the anal side of the jejunogastrostomy with a knifeless linear stapler (L-JIP).MethodsFunctional outcomes were prospectively compared between these two types of reconstruction following laparoscopic PG. Resection and reconstruction were performed using L-DT (n = 10) and L-JIP (n = 10) alternately. Quality of life was evaluated through a questionnaire and endoscopic examination of the ten patients in each group, and functional evaluations were carried out in five patients of each group.ResultsThe postoperative/preoperative body weight ratio was significantly higher in the L-JIP group than in the L-DT group. While the incidence of reflux esophagitis was 10% in both groups, the endoscope could reach the remnant stomach in all patients. In the L-DT group, the plasma acetaminophen concentration at 15 minutes and the insulin level at 30 minutes were markedly increased after oral administration, while the increases in the blood sugar level at 30 and 60 minutes were more gradual than in the L-JIP group.ConclusionsWhile L-JIP may be thought of as the ideal method for function-preserving gastrectomy, L-DT may be suitable for gastric cancer patients with impaired glucose tolerance. These results raise the possibility of individualized selection of reconstruction for gastric cancer patients with various kinds of preoperative complications.

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

“…Furthermore, it is much easier to remove the remnant stomach of DT than JI if the gastric stump disease is detected. Nomura et al [8] also considered DT more suitable for gastric cancer patients with impaired glucose tolerance than JI. Tokunaga regarded that once the length of the interposed jejunum was more than 10 cm, it may pose challenge or even cause failure to postoperative endoscopic examinations [9].…”

“…While there is still lack of agreement that PG-JI or PG-DT can replace TG-RY, PG-JI and PG-DT, as function-preserving surgery, do have several advantages over TG-RY [3,[6][7][8][12][13][14][15][16][17]. First, the remnant stomach offers significantly increased food intake volume and better QOL for patients.…”

“…PG-JI, with its reduction in postoperative body weight loss compared to TG-RY, contributes to better QOL for patients and thus is well adopted [8]. In addition, the incidence of esophageal reflux was reported significantly lower after PG-JI compared to PG-EG [6,9].…”

“…PG-DT, another type of remnant stomach-preserving gestrectomy, is thought to offer better surgical outcomes than PG-JI since it forms two routes, the remnant stomach and the jejunum, allowing adequate food to pass [8,11].…”

A Surgeon’s Role in the Management of Early Esophageal, EGJ and Gastric Lesions

“…In the case of early EGJ lesions, surgical treatment must not be tailored only based on the oncologic outcome, but it must also aid the preservation of the digestive function as much as possible. Several authors published their favorable functional results on proximal gastrectomy and double tract jejunal reconstruction [26,27].…”