Safety and feasibility of novel reconstruction method using long and narrow cobra- head- shaped gastric tube in laparoscopic proximal gastrectomy for cancer

Abstract

Purpose. To clarify the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with our novel reconstruction methods, clinical outcomes of this LPG were evaluated and compared to those of LPG with our conventional method. Methods. Novel method is a reconstruction with a long and narrow gastric tube with widening of the proximal side of the gastric tube created by linear stapler. Esophagogastrostomy is performed by direct anastomosis with overlap method between the posterior wall of the esophagus and anterior wall of the gastric tube using a linear stapler. In conventional method, direct anastomosis between the esophagus and a gastric tube by a circular stapler was performed. Short- and long-term outcomes of a novel method were compared with those of conventional method. Results. A total of 39 patients whom LPG was performed were enrolled in this retrospective study. The amount of blood loss in the Novel method group (n = 30) was significantly less than those in the Conventional method group (n = 9) (40 vs. 110 ml, p < 0.01). No cases of anastomotic leakage and stenosis were observed in both groups. The cases of postoperative reflux esophagitis at 1 year after operation in the Novel group were less than those in the Conventional group (10% vs. 33%). In the Novel group, postoperative recurrence was observed in 2 patients (7%). Conclusion. LPG with novel reconstruction method using long and narrow cobra- head-shaped gastric tube can be easily performed, and may be feasible for the treatment of gastric cancer in the upper third of the stomach.

Esophagogastric Reconstruction in Cobra-Head Shape with Toupet-Like Partial Anti-Reflux Technique for Resection of Proximal Gastric Tumors. Experience with Three Cases from a Non-Asian Population

“…Regarding the oncological safety of the cobra head reconstruction technique, in Asian cases of gastric carcinoma, it has shown similar long-term rates in locoregional recurrence of up to 7%, without a statistically significant difference, even for patients with locally advanced stages [31]. In our three cases treated with this technique, after a median follow-up of 26 months (2 -40 months), no patient has shown locoregional or distant recurrence, even in the patient with the high-risk GIST that was receiving adjuvant therapy with Imatinib.…”