J Korean Surg Soc.  2010 May;78(5):290-297. 10.4174/jkss.2010.78.5.290.

Near-Total Gastrectomy Preserving the Lower Esophageal Sphincter Followed by Jejunal Pouch Interposition as a Treatment for Upper Gastric Cancer

Affiliations
  • 1Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. kimwook@catholic.ac.kr

Abstract

PURPOSE
Conventional total gastrectomy with Roux-en-Y esophagojejunostomy has certain limitations such as insufficient food reservoir and malabsorption of nutrients. Therefore, we performed reconstruction of the jejunal pouch interposition (JPI) after near-total gastrectomy preserving the lower esophageal sphincter (LES). We compared the technical feasibility, safety, and surgical outcome of this operation with conventional total gastrectomy accompanying with Roux-en-Y esophagojejunostomy.
METHODS
From April 2003 to October 2005, 15 LES-preserving, near-total gastrectomies with JPI (LES-JPI group) were performed. The clinical features and surgical outcomes were retrospectively compared with 17 cases of conventional R-Y esophagojejunostomy. Statistical analysis was performed using Fisher's exact test for categorical data and an unpaired t-test for continuous data.
RESULTS
Clinicopathological features of the LES-JPI and R-Y groups did not show differences excepting patient age (50.8+/-5.8 years vs. 62.8+/-12.4, respectively; P=0.002) and the depth of tumor invasion (T1-T2; 11~4 vs. 5~12; P=0.032). The operative outcomes for the two groups significantly differed in terms of operation time (676 vs. 484 min; P=0.008) and blood loss (424 vs. 336 ml; P=0.006). Postoperative gastrofiberscopic examination of all LES-JPI patients showed no esophageal reflux or strictures and intact LES. In addition, the LES-JPI group did not experience swallowing difficulty or stricture.
CONCLUSION
LES-preserving total gastrectomy with JPI is a feasible and safe procedure for patients with upper gastric cancer.

Keyword

Gastric cancer; Lower esophageal sphincter; Jejunal pouch interposition

MeSH Terms

Constriction, Pathologic
Deglutition
Esophageal Sphincter, Lower
Gastrectomy
Gastroesophageal Reflux
Humans
Retrospective Studies
Stomach Neoplasms
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