Browse > Article
http://dx.doi.org/10.5230/jgc.2015.15.3.191

Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis  

Huh, Yeon-Ju (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Lee, Hyuk-Joon (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Oh, Seung-Young (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Lee, Kyung-Goo (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Yang, Jun-Young (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Ahn, Hye-Seong (Department of Surgery, Seoul National University Boramae Medical Center)
Suh, Yun-Suhk (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Kong, Seong-Ho (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Lee, Kuhn-Uk (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Yang, Han-Kwang (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
Publication Information
Journal of Gastric Cancer / v.15, no.3, 2015 , pp. 191-200 More about this Journal
Abstract
Purpose: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.
Keywords
Stomach neoplasms; Laparoscopy; Gastrectomy;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Katsoulis IE, Robotis JF, Kouraklis G, Yannopoulos PA. What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus? Dig Surg 2006;23:325-330.   DOI
2 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.   DOI
3 Hirai T, Matsumoto H, Iki K, Hirabayashi Y, Kawabe Y, Ikeda M, et al. Lower esophageal sphincter- and vagus-preserving proximal partial gastrectomy for early cancer of the gastric cardia. Surg Today 2006;36:874-878.   DOI
4 Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, et al. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996;111:85-92.   DOI
5 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.   DOI
6 Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 2003;90:850-853.   DOI
7 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.   DOI
8 Imada T, Rino Y, Takahashi M, Suzuki M, Tanaka J, Shiozawa M, et al. Postoperative functional evaluation of pyloruspreserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy. Surgery 1998;123:165-170.   DOI
9 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 2011;14:113-123.   DOI
10 Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery 1998;123:127-130.   DOI
11 Lim HJ, Jeong YJ, Yang DH. A comparative study on the outcomes of total and proximal gastrectomies performed for gastric cancer. Korean J Gastroenterol 2002;40:364-370.
12 Park DJ, Lee HJ, Jung HC, Kim WH, Lee KU, Yang HK. Clinical outcome of pylorus-preserving gastrectomy in gastric cancer in comparison with conventional distal gastrectomy with Billroth I anastomosis. World J Surg 2008;32:1029-1036.   DOI
13 Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 2003;90:850-853.   DOI
14 Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Completely laparoscopic proximal gastrectomy with jejunal interposition and lymphadenectomy. J Am Coll Surg 2000;191:114-119.   DOI
15 Pierie JP, de Graaf PW, Poen H, van der Tweel I, Obertop H. Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy. Br J Surg 1993;80:471-474.   DOI
16 Shemesh E, Czerniak A. Comparison between Savary-Gilliard and balloon dilatation of benign esophageal strictures. World J Surg 1990;14:518-521; discussion 521-522.   DOI
17 Brandimarte G, Tursi A. Endoscopic treatment of benign anastomotic esophageal stenosis with electrocautery. Endoscopy 2002;34:399-401.   DOI
18 Hordijk ML, Siersema PD, Tilanus HW, Kuipers EJ. Electrocautery therapy for refractory anastomotic strictures of the esophagus. Gastrointest Endosc 2006;63:157-163.   DOI
19 Bae JM, Park JW, Kim JP. Nutritional assessment and intestinal absorption studies on total gastrectomized gastric cancer patients. Ann Surg Treat Res 1996;50:475-487.
20 Cho SJ, Jegal YJ. Nutritional status, and mucosal morphology of jejunum after total gastrectomy for carcinoma of the stomach. Ann Surg Treat Res 1990;39:726-734.
21 Kim JW, Yoon H, Kong SH, Kim JS, Paeng JC, Lee HJ, et al. Analysis of esophageal reflux after proximal gastrectomy measured by wireless ambulatory 24-hr esophageal pH monitoring and TC-99m diisopropyliminodiacetic acid (DISIDA) scan. J Surg Oncol 2010;101:626-633.   DOI
22 Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Moriya H, et al. Clinical experience of laparoscopy-assisted proximal gastrectomy with Toupet-like partial fundoplication in early gastric cancer for preventing reflux esophagitis. J Am Coll Surg 2009;209:344-351.   DOI
23 Nakamura M, Nakamori M, Ojima T, Katsuda M, Iida T, Hayata K, et al. Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: an analysis of our 13-year experience. Surgery 2014;156:57-63.   DOI
24 Kim DJ, Lee JH, Kim W. Lower esophageal sphincter-preserving laparoscopy-assisted proximal gastrectomy in patients with early gastric cancer: a method for the prevention of reflux esophagitis. Gastric Cancer 2013;16:440-444.   DOI
25 Kinoshita T, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T. Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery. Surg Endosc 2013;27:146-153.   DOI
26 Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E. Evaluation of symptoms related to reflux esophagitis in patients with esophagogastrostomy after proximal gastrectomy. Langenbecks Arch Surg 2013;398:697-701.   DOI