Phase I Clinical Research of Jejunal Interposition in Adenocarcinoma of the Esophagogastric Junction II/III Proximal Gastrectomy

Abstract

Objective. To investigate the feasibility and specific methods of single-tract jejunal interposition between esophagus and remnant stomach (ers-STJI) in adenocarcinoma of the esophagogastric junction (AEG) II/III proximal gastrectomy. Methods. 15 AEG II/III gastric cancer (GC) patients in phase T1-3N0M0 with tumor size <5 cm were selected and they underwent proximal gastrectomy with ers-STJI from August 2013 to August 2014. Results. All of the 15 patients successfully completed GC R0 proximal gastrectomy with ers-STJI and no operative death or no significant complication occurred; one patient had anastomotic inflammatory granuloma. The digestive tract reconstruction time was 29.5 ± 5.7 min; the intraoperative blood loss was 96.7 ± 20.2 mL, and the number of lymph node dissections was 21.3 ± 3.0; the postoperative flatus time was 48.2 ± 11.9 h; the average length of hospital stay was 10.7 ± 2.3 d, and the average hospital stay cost was 60 ± 3 thousands. All of the patients were followed up for 12 months, and their postoperative single food intake, body weight, hemoglobin, and albumin were all recovered to the preoperative levels. Conclusions. The applications of ers-STJI in proximal gastrectomy were safe and feasible, and the length of jejunal interposition could be 15–25 cm.

Novel abdominal approach for dissection of advanced type II/III adenocarcinoma of the esophagogastric junction: a new surgical option

“…9 The transhiatal approach can reduce the risk of postoperative pulmonary complications compared with thoracotomy. 14,24,25 Therefore, transhiatal D2 lymphadenectomy has become a common surgical approach for Siewert type II/III AEG.…”

Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study

“…About 300 patients with AEG admitted to Shanxi Tumor Hospital from June 2015 to December 2017 were selected. Inclusion criteria: Patients (1) aged 18 to 75 years; (2) with cT l-3 N 0 M 0 [TNM staging (AJCC 8th edition [8]) was used as the standard Siewert II or III type AEG]. The location of the AEG was defined as lower margin of palisading small vessels on endoscopy according to the Japanese Classification of Esophageal Cancer (11th edition) [9]; (3) tumor from lower dentate line ≤ 4 cm, the tumor diameter < 4 cm; (4) with primary tumors without distant metastasis; (5) with no surgical contraindications; and (6) with no history of malignant tumor surgery.…”

“…All the patients in three groups were followed up to 30 months after surgery, and the patients were followed up by telephone and returned to the hospital regularly for review. Visick score [8] was used to evaluate gastroesophageal reflux symptoms 18 months postoperatively: Visick grade I, asymptomatic; Visick grade II, occasional symptoms; Visick grade III, apparent but tolerable symptoms; and Visick grade IV, apparent and intolerable symptoms.…”

“…In China, piggyback jejunal interposition reconstruction (PJIR), proposed by Shanxi Tumor Hospital, was performed on the basis of Roux-en-Y jejunal anastomosis on the jejunum of the esophagus, and then jejunal remnant jejunostomy was performed on the appropriate location of jejunum loop. PJIR is divided into single-tract reconstruction (STR) and double-tract reconstruction (DTR), and its efficacy has been preliminarily verified [8]. However, there is still no consensus on the method of digestive tract reconstruction for Siewert II and III AEG patients.…”

Surgical Strategies for Siewert Type II Esophagogastric Junction Carcinomas: A Randomized Controlled Trial

“…The study's secondary endpoints were 5-year progression-free survival, overall survival, cumulative probability of recurrence and cumulative probability of mortality. We also determined the values of several nutrition indices: (1) the amount of single meal, (2) body weight, (3) albumin, (4) hemoglobin, (5) pepsin, (6) gastrin; and quality of life measures, i.e., (1) the classification of gastroesophageal reflux symptoms (Visick classification) ( 15), (2) the classification of endoscopic reflux symptoms (Los Angeles, LA) (16), and (3) the Gastrointestinal Symptom Rating Scale (GSRS) (13). The blood loss, the operative time, postoperative time to first flatus, length of hospitalization was also recorded.…”