Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer

Sang Hoon Ahn, Do Hyun Jung, Sang Yong Son, Chang Min Lee, Do Joong Park, Hyung Ho Kim

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Proximal gastrectomy is not routinely performed because it is associated with increased reflux symptoms and anastomotic strictures. The purpose of this study is to describe a novel method of laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) for proximal early gastric cancer (EGC), and to evaluate the technical feasibility, safety, and short-term surgical outcomes, especially reflux symptoms, after LPG. Methods: Retrospective review of the prospective cohort data of 43 patients who presented to a single tertiary hospital from June 2009 through April 2012 and underwent LPG with DTR for proximal EGC. The data of this prospective cohort were analyzed, and the reflux symptoms, clinicopathologic characteristics, surgical outcomes, postoperative morbidities and mortalities, and follow-up findings were analyzed. Results: The mean surgical time was 180.7 min; mean estimated blood loss, 120.4 mL; mean length of the proximal resection margin, 4.13 cm; mean number of retrieved lymph nodes, 41.2; and mean postoperative hospital stay, 7.1 days. Early complication rate was 11.6 % (n = 5); major complication (grade higher than Clavien-Dindo IIIa) occurred in 1 patient (2.3 %). Late complication rate was 11.6 % (n = 5): 2 patients had esophagojejunostomy stenosis, which was successfully treated with fluoroscopic balloon dilatations; 1, chylous ascites; and 2 had Visick grade II reflux symptoms (4.6 %), managed by medication during the mean follow-up period of 21.6 months. Conclusion: DTR after LPG is a feasible, simple, and novel reconstruction method with excellent postoperative outcomes in terms of preventing reflux symptoms. Its clinical applicability must be validated by prospective randomized trials.

Original languageEnglish
Pages (from-to)562-570
Number of pages9
JournalGastric Cancer
Volume17
Issue number3
DOIs
Publication statusPublished - 2014 Jan 1
Externally publishedYes

Fingerprint

Gastrectomy
Stomach Neoplasms
Pathologic Constriction
Chylous Ascites
Operative Time
Tertiary Care Centers
Dilatation
Length of Stay
Lymph Nodes
Morbidity
Safety
Mortality

Keywords

  • Double tract reconstruction (DTR)
  • Gastric cancer
  • Laparoscopic proximal gastrectomy (LPG)
  • Laparoscopy
  • Proximal EGC
  • Proximal gastrectomy

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. / Ahn, Sang Hoon; Jung, Do Hyun; Son, Sang Yong; Lee, Chang Min; Park, Do Joong; Kim, Hyung Ho.

In: Gastric Cancer, Vol. 17, No. 3, 01.01.2014, p. 562-570.

Research output: Contribution to journalArticle

Ahn, Sang Hoon ; Jung, Do Hyun ; Son, Sang Yong ; Lee, Chang Min ; Park, Do Joong ; Kim, Hyung Ho. / Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. In: Gastric Cancer. 2014 ; Vol. 17, No. 3. pp. 562-570.
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T1 - Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer

AU - Ahn, Sang Hoon

AU - Jung, Do Hyun

AU - Son, Sang Yong

AU - Lee, Chang Min

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AU - Kim, Hyung Ho

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AB - Background: Proximal gastrectomy is not routinely performed because it is associated with increased reflux symptoms and anastomotic strictures. The purpose of this study is to describe a novel method of laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) for proximal early gastric cancer (EGC), and to evaluate the technical feasibility, safety, and short-term surgical outcomes, especially reflux symptoms, after LPG. Methods: Retrospective review of the prospective cohort data of 43 patients who presented to a single tertiary hospital from June 2009 through April 2012 and underwent LPG with DTR for proximal EGC. The data of this prospective cohort were analyzed, and the reflux symptoms, clinicopathologic characteristics, surgical outcomes, postoperative morbidities and mortalities, and follow-up findings were analyzed. Results: The mean surgical time was 180.7 min; mean estimated blood loss, 120.4 mL; mean length of the proximal resection margin, 4.13 cm; mean number of retrieved lymph nodes, 41.2; and mean postoperative hospital stay, 7.1 days. Early complication rate was 11.6 % (n = 5); major complication (grade higher than Clavien-Dindo IIIa) occurred in 1 patient (2.3 %). Late complication rate was 11.6 % (n = 5): 2 patients had esophagojejunostomy stenosis, which was successfully treated with fluoroscopic balloon dilatations; 1, chylous ascites; and 2 had Visick grade II reflux symptoms (4.6 %), managed by medication during the mean follow-up period of 21.6 months. Conclusion: DTR after LPG is a feasible, simple, and novel reconstruction method with excellent postoperative outcomes in terms of preventing reflux symptoms. Its clinical applicability must be validated by prospective randomized trials.

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KW - Gastric cancer

KW - Laparoscopic proximal gastrectomy (LPG)

KW - Laparoscopy

KW - Proximal EGC

KW - Proximal gastrectomy

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