Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach

Abstract

Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopyassisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant stomach by using the OrVil TM system. The reconstruction method was Rouxen-Y, and hemidouble-stapling gastrojejunostomy with a circular stapler was performed intracorporeally. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 266.7 min and 54.6 ml, respectively. The overall incidence of early postoperative complications was 17.4%, and two patients underwent reoperation because of duodenal stump leakage and stenosis of the Y-anastomosis, respectively. During the follow-up period, two patients experienced gastrojejunostomy stenosis and both were treated successfully by endoscopic balloon dilation. LAsTG may be performed in selected patients with EGC in the upper stomach. With the described method, a very small remnant stomach can be preserved.

Potentially fatal complications for elderly patients after laparoscopy-assisted distal gastrectomy

“…However, an intraperitoneal pressure of 8 mmHg was sometimes selected if a lower cardiopulmonary reserve was expected. A total of five ports (each 5-12 mm) were inserted, and LADG with perigastric and suprapancreatic lymph node dissection was conducted as reported previously [22][23][24][25][26]. Extracorporeal reconstruction was performed using a 4-to 5-cm upper midline incision with Billroth-I reconstruction after LADG.…”

Gastric Resection Under Retroflexed Endoscopic Guidance: A Reliable Procedure for Totally Laparoscopic Subtotal Gastrectomy

“…In this study, the margin size was similar to those reported in previous studies evaluating subtotal The gastric occlusion line (thick black arrows), metal clips (thin black arrow), and the tumor (white arrow) can be seen in the same view when using gastroscopic retroflexion. gastrectomy [16,19] . Although few reports have described the transection time including the time for gastroscopy [14] , we believe the transection achieved using GRREG for TLDG was acceptable and beneficial.…”

“…However, the definitive method for gastric transection with a safe cancer margin has not been established fully, especially for patients with early gastric cancer in the middle or upper stomach. Some reports have advocated the usefulness of intraoperative gastroscopy [14][15][16][17][18] with preoperative marking using metal clips. Nevertheless, there are concerns with regard to utilizing the normal gastroscopic forward view.…”

“…A further 4 trocars were inserted laparoscopically according to the standard '5-port method' [5,16] ( fig. 1 ).…”

Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

“…23 However, this procedure is complicated and requires the use of advanced techniques. Conversely, the anastomosis with a circular stapler could be simply placed on the transection line of the minimal remnant stomach, 14,24,25 although the anvil of the circular stapler must be inserted into the small remnant stomach. Kosuga et al used the OrVil for all of their patients.…”