J Gastric Cancer.  2015 Sep;15(3):191-200. 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 YJ
• Lee HJ
• Oh SY
• Lee KG
• Yang JY
• Ahn HS
• Suh YS
• Kong SH
• Lee KU
• Yang HK

• KMID: 2372205
• DOI: http://doi.org/10.5230/jgc.2015.15.3.191

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.

Keyword

Stomach neoplasms; Laparoscopy; Gastrectomy

MeSH Terms

Esophagitis, Peptic*
Esophagus
Gastrectomy*
Humans
Incidence
Laparoscopy
Medical Records
Nutritional Status
Postoperative Complications
Prognosis
Recurrence
Stomach Neoplasms*
Survival Rate

Figure

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  Fig. 1 Differences between conventional proximal gastrectomy (PG) and modified laparoscopy-assisted PG (mLAPG). (A) In conventional PG, the vagus nerve was sacrificed, and pyloroplasty was performed in selective cases. The proximal resection line was made distal to the esophagus. (B) In mLAPG, we aimed to preserve the hepatic branch of the vagus nerve and not perform pyloroplasty. The proximal resection line was made at the gastroesophageal junction.

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  Fig. 2 Comparison of overall survival rates between the proximal gastrectomy (PG) and total gastrectomy (TG) groups.

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  Fig. 3 Comparison of recurrence-free survival rates between the proximal gastrectomy (PG) and total gastrectomy (TG) groups.

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