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

• Kim J
• Kim S
• Min YD

Abstract

PURPOSE
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.
MATERIALS AND METHODS
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.
RESULTS
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.
CONCLUSIONS
Cardia preserving proximal gastrectomy was feasible for early gastric cancer of the upper third. Further evaluation and prospective research will be required.

Keyword

Cardia; Gastrectomy; Proximal

MeSH Terms

Biopsy
Cardia
Constriction, Pathologic
Dyspepsia
Endoscopy
Female
Gastrectomy
Gastroesophageal Reflux
Hemorrhage
Humans
Lymph Nodes
Male
Nutritional Status
Postoperative Complications
Recurrence
Stomach Neoplasms

Figure

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

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

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

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

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