J Gastric Cancer.  2012 Sep;12(3):187-193.

Consideration of Cardia Preserving Proximal Gastrectomy in Early Gastric Cancer of Upper Body for Prevention of Gastroesophageal Reflux Disease and Stenosis of Anastomosis Site

  • 1Department of Surgery, Chosun University College of Medicine, Gwangju, Korea. ydmin@chosun.ac.kr


The aim of this study is to evaluate the feasibility and safety of cardia preserving proximal gastrectomy, in early gastric cancer of the upper third.
A total of 10 patients were diagnosed with early gastric cancer of the upper third through endoscopic biopsy. The operation time, length of resection free margin, number of resected lymph nodes and postoperative complications, gastrointestinal symptoms, nutritional status, anastomotic stricture, and recurrence were examined.
There were 5 males and 5 females. The mean age was 56.5+/-0.5 years. The mean operation time was 188.5+/-0.5 minutes (laparoscopic operation was 270 minutes). Nine patients were T1 stage (T2 : 1), and N stage was all N0. The mean number of resected lymph nodes was 25.2+/-0.5. The length of proximal resection free margin was 3.1+/-0.1 cm and distal was 3.7+/-0.1 cm. Early complications were surgical site infection (1), bleeding (1), and gastro-esophageal reflux disease (1) (this symptom was improved with medication). Late complications were dyspepsia (3) (this symptom was improved without any treatment), and others were nonspecific results of endoscopy or symptom.
Cardia preserving proximal gastrectomy was feasible for early gastric cancer of the upper third. Further evaluation and prospective research will be required.


Cardia; Gastrectomy; Proximal

MeSH Terms

Constriction, Pathologic
Gastroesophageal Reflux
Lymph Nodes
Nutritional Status
Postoperative Complications
Stomach Neoplasms


  • Fig. 1 Endoscopic finding of early gastric cancer of upper body near esophagogastric junction.

  • Fig. 2 Resection lines for cardia preserving proximal gastrectomy. RGA = right gastric artery; RGEA = right gastroepiploic artery; LES = low esophageal sphincter.

  • Fig. 3 Final configuration of anastomosis with suture lines after cardia preserving proximal gastrectomy.

  • Fig. 4 Endoscopic follow-up of cardia preserving proximal gastrectomy showing wider anastomotic ring.


1. Hyung WJ, Kim SS, Choi WH, Cheong JH, Choi SH, Kim CB, et al. Changes in treatment outcomes of gastric cancer surgery over 45 years at a single institution. Yonsei Med J. 2008. 49:409–415.
2. http://kostat.go.kr/portal/korea/index.action/. Accessed December 8, 2011.
3. 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.
4. Kim EM, Jeong HY, Lee ES, Moon HS, Sung JK, Kim SH, et al. Comparision between proximal gastrectomy and total gastrectomy in early gastric cancer. Korean J Gastroenterol. 2009. 54:212–219.
5. 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.
6. Olbe L, Lundell L. Intestinal function after total gastrectomy and possible consequences of gastric replacement. World J Surg. 1987. 11:713–719.
7. Sugiura T, Iwakiri K, Kotoyori M, Kobayashi M. Relationship between severity of reflux esophagitis according to the Los Angeles classification and esophageal motility. J Gastroenterol. 2001. 36:226–230.
8. Kim JH, Park SS, Kim J, Boo YJ, Kim SJ, Mok YJ, et al. Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg. 2006. 30:1870–1876.
9. Hinoshita E, Takahashi I, Onohara T, Nishizaki T, Matsusaka T, Wakasugi K, et al. The nutritional advantages of proximal gastrectomy for early gastric cancer. Hepatogastroenterology. 2001. 48:1513–1516.
10. Schwarz A, Büchler M, Usinger K, Rieger H, Glasbrenner B, Friess H, et al. Importance of the duodenal passage and pouch volume after total gastrectomy and reconstruction with the Ulm pouch: prospective randomized clinical study. World J Surg. 1996. 20:60–66.
11. Yoo CH, Sohn BH, Han WK, Pae WK. Proximal gastrectomy reconstructed by jejunal pouch interposition for upper third gastric cancer: prospective randomized study. World J Surg. 2005. 29:1592–1599.
12. Matsushiro T, Hariu T, Nagashima H, Yamamoto K, Imaoka Y, Yamagata R, et al. Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy. Am J Surg. 1986. 152:314–319.
13. 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.
14. Jung HJ, Kim DH, Kim DH. Proximal gastrectomy with double tract reconstruction using the remnant antrum in early opper gastric cancer. J Korean Surg Soc. 2008. 74:261–266.
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