Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

Adachi, Yosuke; Inoue, Tomoyoshi; Hagino, Yoshiaki; Shiraishi, Norio; Shimoda, Katsuhiro; Kitano, Seigo

doi:10.1007/s101200050019

Cited by 68 publications

(84 citation statements)

References 18 publications

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“…When considering the advantages of a minimally invasive surgery and functionpreserving procedures, LAPG is theoretically a better option than LATG. Many functional benefits have been reported for LAPG, including improved nutrition, prevention of anemia, improved release of gut hormones, and a reduction of postoperative complaints [15,16]. Oncologic concerns also have been solved, to some degree; several reports of proximal gastrectomy have shown long-term oncologic outcomes similar to those for total gastrectomy even in advanced disease [17].…”

Section: Discussionmentioning

confidence: 99%

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

et al. 2012

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Background The choice of surgical strategy for patients with proximal gastric cancer is controversial. The purpose of this study was to assess the feasibility, safety, and surgical and functional outcomes of laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG). Methods Between June 2003 and December 2009, 131 patients with proximal gastric cancer underwent LAPG (n = 50) or LATG (n = 81) at Seoul National University Bundang Hospital. We reviewed their medical and surgical records from our prospectively collected gastric cancer database. The clinicopathologic characteristics and shortterm, long-term, and functional outcomes were compared between the 2 groups. Results There were no significant differences in demographics, T-stage, N-stage, or survival between the 2 groups. The LAPG group had a shorter operative time and lower estimated blood loss than the LATG group. The early complication rates after the LAPG and LATG procedures were 24.0 and 17.3 %, respectively (p = 0.349). The incidence of reflux symptoms was significantly higher in the LAPG group (32.0 vs. 3.7 %, p \ 0.001). The parameters that reflected nutritional status were similar in the 2 groups. Conclusion LAPG is a feasible and acceptable method for treating proximal early gastric cancer in terms of surgical and oncologic safety. However, esophagogastrostomy after LAPG was associated with an increased risk of reflux symptoms. Antireflux procedures should be considered to prevent reflux symptoms after LAPG.

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Section: Discussionmentioning

confidence: 99%

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

et al. 2012

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“…For earlystage proximal gastric cancer, proximal gastrectomy has been employed [1][2][3][4][5][6]. Although laparoscopic distal gastrectomy has recently been widely employed for early gastric cancer [9][10][11][12], reports of laparoscopic proximal gastrectomy are rare [8,13].…”

Section: Discussionmentioning

confidence: 99%

“…However, such additional procedures are difficult to perform laparoscopically. To reduce postoperative reflux esophagitis and to simplify the anastomotic procedure, Kitano's group [3,13,20] employed gastric tube reconstructions (which have been used after thoracic esophagectomy for esophageal cancer) after laparoscopy-assisted or open proximal gastrectomies. We feel that the procedure used by this group is excellent.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy

et al. 2001

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trectomies in two patients with gastric cancer. Here, we describe our surgical procedure and the postoperative courses of these two patients. Surgical procedureEach patient was placed under general anesthesia in the supine, reverse Trendelenburg position with the legs apart. The surgeon stood on the patient's right, with the assisting surgeon on the patient's left, and the camera operator stood between the patient's legs. Pneumoperitoneum was then established, using an open technique, and five working ports (each 12 mm in diameter) were then placed.Laparoscopic mobilization and transection of the stomach, and lymphadenectomy (which consisted of a limited dissection A according to the new Japanese practice guidelines for gastric cancer) were performed by the same methods as those that we reported previously ( Fig. 1) [8]. In our procedure, in order to prevent pyloric stenosis, postoperative diarrhea, and an increased risk of cholelithiasis, the vagal pyloric, celiac, and hepatic branches were preserved. Accordingly, the esophagus was not transected until after anastomosis, to allow the esophagogastrostomy to be performed safely. Side-to-side esophagogastrostomyThis anastomosis involves attaching the posterior aspect of the esophagus to the anterior wall of the gastric remnant. There must be sufficient overlap so that 5-6 cm of esophagus will lie freely over the front of the gastric remnant. Therefore, the esophagus was sufficiently mobilized to allow this. The posterior wall of the esophagus was excised, and a 1-cm stab wound was made in the anterior wall of the gastric remnant, approximately 5-6 cm from the staple lines of the stump. A 45-mm endoscopic linear stapler (ETS45; Ethicon Endo-Surgery, AbstractIn order to improve anastomotic procedures, we performed laparoscopic side-to-side esophagogastrostomy, using a linear stapler, after proximal gastrectomy in two patients with gastric cancer located in the upper third of the stomach. The patients' postoperative courses were excellent. During postoperative recovery, the patients experienced very little pain, used no analgesic medications, and never experienced reflux esophagitis. This procedure is technically feasible and is an excellent option, given the less involved anastomotic procedure and better postoperative quality of life compared with these features in end-to-side anastomosis using a circular stapler.

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“…In spite of functional benefits such as improved postoperative nutrition, preventing anemia, and release of gut hormones, PG has not gained in popularity, mainly due to postoperative complications such as esophageal reflux and anastomotic stricture [60][61][62][63][64] . To overcome these complications, various reconstruction methods and esophagojejunostomies have been developed, including jejunal interposition and double tract reconstruction, which are considered to be superior to esophagogastrostomy in preventing postoperative esophageal reflux.…”

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confidence: 99%

Minimally Invasive Surgery of Gastric Cancer

Güner

Hyung

2017

Minimally Invasive Surgery for Upper Abdominal Cancer

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Minimally invasive surgery for gastric cancer has rapidly gained popularity due to the early detection of early gastric cancer. As advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Recent evidence suggests that the short-and long-term outcomes of minimally invasive surgery for early gastric cancer and advanced gastric cancer are comparable to those of conventional open surgery. However, these results should be confirmed by large-scale multicenter prospective randomized controlled clinical trials.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Gastric cancer; Minimally invasive surgery; Laparoscopic gastrectomyCore tip: Minimally invasive surgery has become an alternative modality for the treatment of gastric cancer.Son SY, Kim HH. Minimally invasive surgery in gastric cancer. World J Gastroenterol 2014; 20(39): 14132-14141 Available from: URL: http://www.wjgnet.com/1007-9327/full/ v20/i39/14132.htm DOI: http://dx.doi.org/10.3748/wjg.v20. tano et al [9] and Nagai et al [10] reported the success of laparoscopy-assisted distal gastrectomy (LADG) for EGC in 1994 and 1995. In the early 2000s, robot-assisted surgery emerged as one of the treatment modalities for EGC, and the first robot-assisted gastrectomy (RAG) for EGC was reported by Hashizume et al [11] in 2003. In 2011, singleincision laparoscopic surgery was described for EGC [12] . MIS has revolutionized the surgical approach to gastric cancer for the past two decades, leading to improvements in patients' quality of life by producing less pain, less blood loss, earlier postoperative recovery, and a shorter hospital stay [13][14][15][16][17][18][19] .Currently, MIS is evolving in two major directions [20] . First, MIS techniques are being used in more radical but less invasive procedures, such as totally laparoscopic distal gastrectomy or laparoscopic total gastrectomy with D1+ or D2 lymphadenectomy. These procedures are comparable to conventional open surgery and can be performed even in patients with advanced gastric cancer (AGC) [21][22][23] . Second, MIS is being employed for function-preserving surgery, including pylorus-preserving gastrectomy (PPG), proximal gastrectomy, and limited gastrectomy with sentinel node navigation surgery. These procedures can assist in improving patients' late postoperative function and quality of life [20,[24][25][26] . RECENT ADVANCES IN LAPAROSCOPIC GASTRECTOMYAs advances in instruments and the accumulation of laparoscopic experience increase, laparoscopic techniques are being used for less invasive but highly technical procedures. Totally laparoscopic gastrectomy (TLG) is one example. TLG has gained popularity since Kanaya et al [27] reported the first delta-shaped anastomosis. A recent meta-analysis (five studies, 652 patients) showed that totally laparoscopic distal gastrectomy has less bleeding, shorter time to first flatus, and lower rates of postoperative complicat...

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Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

Cited by 68 publications

References 18 publications

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer

Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy

Minimally Invasive Surgery of Gastric Cancer

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