DOI QR코드

DOI QR Code

Comparing Pre- and Post-Operative Findings in Patients Who Underwent Laparoscopic Proximal Gastrectomy With a Double-Flap Technique: A Study on High-Resolution Manometry, Impedance pH Monitoring, and Esophagogastroduodenoscopy Findings

  • Hyun Joo Yoo (Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Jin-Jo Kim (Division of Gastrointestinal Surgery, Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2023.08.21
  • Accepted : 2023.10.19
  • Published : 2024.04.01

Abstract

Purpose: Laparoscopic proximal gastrectomy (LPG) is a viable choice for treating proximal gastric lesions. However, the occurrence of severe reflux has limited its widespread adoption. To address this issue, the double flap technique (DFT), which incorporates artificial lower esophageal sphincteroplasty, has been developed to prevent reflux problems after proximal gastrectomy. In this study, we aimed to investigate the usefulness of this technique using high-resolution manometry (HRM), impedance pH monitoring, and esophagogastroduodenoscopy (EGD). Materials and Methods: The findings of pre- and postoperative 6-month HRM, pH monitoring, and EGD were compared for 9 patients who underwent LPG with DFT for various proximal gastric lesions at Incheon St. Mary's Hospital from January 2021 to December. Results: A total of 9 patients underwent proximal gastrectomy. Approximately half of the patients had Hill's grade under II preoperatively, whereas all patients had Hill's grades I and II in EGD findings. In the HRM test, there was no significant difference between distal contractile integral (1,412.46±1,168.51 vs. 852.66±495.62 mmHg·cm·s, P=0.087) and integrated relaxation pressure (12.54±8.97 vs. 8.33±11.30 mmHg, P=0.27). The average lower esophageal sphincter (LES) pressure was 29.19±14.51 mmHg preoperatively, which did not differ from 19.97±18.03 mmHg after the surgery (P=0.17). DeMeester score (7.02±6.36 vs. 21.92±36.17, P=0.21) and total acid exposure time (1.49±1.48 vs. 5.61±10.17, P=0.24) were slightly higher, but the differences were not statistically significant. Conclusions: There is no significant functional difference in HRM and impedance pH monitoring tests after DFT. DFT appears to be useful in preserving LES function following proximal gastrectomy.

Keywords

References

  1. Arnold M, Park JY, Camargo MC, Lunet N, Forman D, Soerjomataram I. Is gastric cancer becoming a rare disease? A global assessment of predicted incidence trends to 2035. Gut 2020;69:823-829. https://doi.org/10.1136/gutjnl-2019-320234
  2. Information Committee of the Korean Gastric Cancer Association. Korean Gastric Cancer Association-led nationwide survey on surgically treated gastric cancers in 2019. J Gastric Cancer 2021;21:221-235. https://doi.org/10.5230/jgc.2021.21.e27
  3. Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 2011;98:255-260.
  4. Kusano C, Gotoda T, Khor CJ, Katai H, Kato H, Taniguchi H, et al. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol 2008;23:1662-1665. https://doi.org/10.1111/j.1440-1746.2008.05572.x
  5. Steevens J, Botterweck AA, Dirx MJ, van den Brandt PA, Schouten LJ. Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 2010;22:669-678.
  6. An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 2008;196:587-591. https://doi.org/10.1016/j.amjsurg.2007.09.040
  7. Nakamura M, Yamaue H. Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014. Surg Today 2016;46:517-527. https://doi.org/10.1007/s00595-015-1185-4
  8. Tanioka T, Waratchanont R, Fukuyo R, Saito T, Umebayashi Y, Kanemoto E, et al. Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis. Surg Endosc 2020;34:1061-1069.
  9. Takiguchi N, Takahashi M, Ikeda M, Inagawa S, Ueda S, Nobuoka T, et al. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer 2015;18:407-416. https://doi.org/10.1007/s10120-014-0377-8
  10. Masuzawa T, Takiguchi S, Hirao M, Imamura H, Kimura Y, Fujita J, et al. Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg 2014;38:1100-1106. https://doi.org/10.1007/s00268-013-2370-5
  11. Park JY, Park KB, Kwon OK, Yu W. Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy in terms of nutritional status or quality of life in early gastric cancer patients. Eur J Surg Oncol 2018;44:1963-1970. https://doi.org/10.1016/j.ejso.2018.08.014
  12. Shiraishi N, Adachi Y, Kitano S, Kakisako K, Inomata M, Yasuda K. Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg 2002;26:1150-1154. https://doi.org/10.1007/s00268-002-6369-6
  13. Nozaki I, Hato S, Kobatake T, Ohta K, Kubo Y, Kurita A. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg 2013;37:558-564. https://doi.org/10.1007/s00268-012-1894-4
  14. Kameyama J, Ishida H, Yasaku Y, Suzuki A, Kuzu H, Tsukamoto M. Proximal gastrectomy reconstructed by interposition of a jejunal pouch. Surgical technique. Eur J Surg 1993;159:491-493.
  15. Adachi Y, Inoue T, Hagino Y, Shiraishi N, Shimoda K, Kitano S. Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction. Gastric Cancer 1999;2:40-45. https://doi.org/10.1007/s101200050019
  16. Kamikawa Y, Kobayashi T, Kamiyama S, Satomoto K. A new procedure of esophagogastrostomy to prevent reflux following proximal gastrectomy. Shoukakigeka 2001;24:1053-1060.
  17. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999;45:172-180. https://doi.org/10.1136/gut.45.2.172
  18. Hill LD, Kozarek RA, Kraemer SJ, Aye RW, Mercer CD, Low DE, et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 1996;44:541-547. https://doi.org/10.1016/S0016-5107(96)70006-8
  19. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, et al. The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 2015;27:160-174. https://doi.org/10.1111/nmo.12477
  20. Johnson LF, DeMeester TR. Development of the 24-hour intraesophageal pH monitoring composite scoring system. J Clin Gastroenterol 1986;8 Suppl 1:52-58. https://doi.org/10.1097/00004836-198606001-00008
  21. Bartlett EK, Roses RE, Kelz RR, Drebin JA, Fraker DL, Karakousis GC. Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery 2014;156:298-304. https://doi.org/10.1016/j.surg.2014.03.022
  22. Li SS, Costantino CL, Mullen JT. Morbidity and mortality of total gastrectomy: a comprehensive analysis of 90-day outcomes. J Gastrointest Surg 2019;23:1340-1348. https://doi.org/10.1007/s11605-019-04228-7
  23. Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, et al. Long-term outcomes of patients who underwent limited proximal gastrectomy. Gastric Cancer 2014;17:141-145. https://doi.org/10.1007/s10120-013-0257-7
  24. Wang S, Lin S, Wang H, Yang J, Yu P, Zhao Q, et al. Reconstruction methods after radical proximal gastrectomy: a systematic review. Medicine (Baltimore) 2018;97:e0121.