Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery.
ABSTRACT BACKGROUND: The incidence of cancer in the proximal third of the stomach is increasing. Laparoscopic proximal gastrectomy (LPG) seems an attractive option for the treatment of early-stage proximal gastric cancer but has not gained wide acceptance because of technical difficulties, including the prevention of severe reflux. In this study, we describe our technique for LPG with jejunal interposition (LPG-IP) and evaluate its safety and feasibility. METHODS: In this retrospective analysis, we reviewed the data of patients with proximal gastric cancer who underwent LPG-IP (n = 22) or the same procedure with open surgery (OPG-IP; n = 68) between January 2008 and September 2011. Short-term surgical variables and outcomes were compared between the groups. The reconstruction method was the same in both groups, with creation of a 15 cm, single-loop, jejunal interposition for anastomosis. RESULTS: There were no differences in patient or tumor characteristics between the groups. Operation time was longer in the LGP-IP group (233 vs. 201 min, p = 0.0002) and estimated blood loss was significantly less (20 vs. 242 g, p < 0.0001). The average number of harvested lymph nodes did not differ between the two groups (17 vs. 20). There also were no differences in the incidence of leakage at the esophagojejunostomy anastomosis (9.1 vs. 7.4 %) or other postoperative complications (27 vs. 32 %). The number of times additional postoperative analgesia was required was significantly less in the LPG-IP group compared with the OPG-IP group (2 vs. 4, p < 0.0001). CONCLUSIONS: LPG-IP has equivalent safety and curability compared with OPG-IP. Our results imply that LPG-IP may lead to faster recovery, better cosmesis, and improved quality of life in the short-term compared with OPG-IP. Because of the limitations of retrospective analysis, a further study should be conducted to obtain definitive conclusions.
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ABSTRACT: The purpose of this study was to evaluate the quality of life (QOL) after laparoscopy-assisted distal gastrectomy (LADG) compared with open distal gastrectomy (ODG) in patients with early gastric cancer. LADG has been beneficial in terms of pain, recovery, and morbidity when compared with open surgery with equal oncologic outcome. There has been no clinical study on QOL. From July 2003 to November 2005, 164 patients with newly diagnosed cT1N0M0 and cT1N1M0 distal gastric cancer were randomly assigned either to LADG or ODG. All patients were asked to complete the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-STO22 questionnaires preoperatively and postoperatively on regular follow-up visits. Statistically significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss (P < 0.001), total amount of analgesics used (P = 0.019), the size of the wound (P < 0.0001), postoperative hospital stay (P < 0.0001), and QOL parameters of global health (P < 0.0001). Most of the scales on patient functioning including physical (P < 0.0005), role (P = 0.0011), emotional (P < 0.0001), social (P < 0.0001), and symptom scales such as fatigue (P < 0.0001), pain (P < 0.0001), appetite loss (P = 0.031), sleep disturbance (P = 0.003), dysphasia (P = 0.0024), gastro-esophageal reflux (P = 0.0127), dietary restriction (P = 0.0004), anxiety (P = 0.0036), dry mouth (P = 0.0007), and body image (P < 0.0001) were also significantly better in the LADG group compared with the ODG group. Comparison of LADG to ODG in patients with early gastric cancer resulted in improved QOL outcomes in the patients followed for up to 3 months in the LADG group.Annals of surgery 11/2008; 248(5):721-7. · 7.90 Impact Factor
- Journal of the American College of Surgeons 08/2000; 191(1):114-9. · 4.50 Impact Factor
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ABSTRACT: Recently, the frequency of early gastric cancer in the upper third of the stomach has especially increased. We have improved the esophagogastrostomy procedure to maximize the preservation of physiologic functions. Eleven patients were reconstructed by esophagogastrostomy with an incision in the left abdomen after limited proximal gastrectomy. We presented here the details of this reconstructive method and demonstrated the results of postoperative evaluations of the lower esophagus and the remaining stomach. Median surgical duration and blood loss was 330 min and 32 ml for this procedure. The approach using circular stapler from the left side allowed a good laparoscopic visual field to be obtained for the plane of the esophagogastrostomy. The reconstructive procedure was successfully performed without intraoperative complications. There were no anastomosis-related postoperative complications encountered in ten patients, but delayed anastomotic stenosis occurred in one patient. This technique preserved the lower esophageal sphincter as well as peristalsis of the lower stomach and also allowed the greater curvature near the top of the stomach to function as a new fundus. The incidence of reflux esophagitis on endoscopic examination was limited. This approach for esophagogastrostomy with an incision in the left abdomen could be a simple, easy, and safe reconstructive technique after laparoscopy-assisted proximal gastrectomy with preservation of maximal physiologic function of the remnant stomach.Langenbeck s Archives of Surgery 08/2011; 397(1):57-62. · 1.89 Impact Factor