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

Abstract

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.

Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis

“…Additionally, it was found that the preventive reflux methods within several techniques increased the incidence of residual food, reflux esophagitis, anastomotic stricture, and anastomotic leakage in all the reconstruction methods, but DFT recorded in the studies observed low incidence of complications 8.9%, 5.5%, 1.4% and 3.9% respectively. Individual studies also recorded a low incidence of complications [22,31,37,40,44]. DFT conducted after proximal gastrectomy seemed to be proven effective to lower the outcome as compared to the procedures of DTR, JPI, JI, and EG.…”

“…The remaining 29 studies were included as shown in senmaru et al [26], kameyama et al [21], isobe et al [27], kazuhiro et al [28], adachi et al [29], kondoh et al [30], yasuda et al [32], ahn et al [45], nomura et al [33], sugiyama et al [46], tokunaga et al [35], ohashi et al [47], tanaka et al [38], aburatani et al . [40], nakamura et al [41], katai et al [16], masuzawa et al [42] and takayama et al [43], kano et al [44], koruda et al [22], omori et al [31], and saeki et al [37], 2 papers from Korea, Kim et al [23] and yang et al [34], and 1 paper from Scotland, wright et al [36]. Studies reported postoperative outcomes such as reflux esophagitis, anastomotic leakage, anastomotic stricture, and residual food shown in Table 2.…”

“…Four studies [22,31,37,44] reported double flap reconstruction with a total of 560 patients involved. Postoperative results including reflux esophagitis, anastomotic stricture, anastomotic leakage, and residual food were observed with an incidence of 8.9%, 5.5%, 1.4%, and 3.9% respectively.…”

Current status of proximal gastrectomy for gastric and esophagogastric junctional cancer: A review

“…Another interesting decision‐making question is whether to choose PG or subtotal gastrectomy for EGC of the upper stomach 21 . Subtotal gastrectomy may be possible for lesser curvature lesions 3 cm from the EGJ.…”

Current status of function‐preserving gastrectomy for gastric cancer

“…PNI) are presented in Table3 [37][38][39]. Kosuga et al39 first reported that patients undergoing LSTG had a significantly higher postoperative BW, and serum Alb and TP levels, than those undergoing LTG.…”