title: Lower esophageal sphincter- and vagus-preserving proximal partial gastrectomy for early cancer of the gastric cardia.
abstract: OBJECTIVE
  Proximal gastrectomy and lymph node dissection are often performed for T1 cancer of the gastric cardia; however, direct esophagogastrostomy is frequently complicated by reflux esophagitis. We describe a simple technique for preventing esophageal reflux and discuss its results.
  
  
  METHODS
  This technique is indicated for T1 cancer of the gastric cardia without lymphadenopathy. Partial resection, including the lesion, is performed, preserving the vagus nerve and lower esophageal sphincter (LES). Lymph node dissection is done around the left gastric, celiac, and splenic arteries. The esophagus is then anastomosed to the anterior wall in the center of the remnant stomach.
  
  
  RESULTS
  We evaluated the results of this procedure in eight patients. X-ray films showed no esophageal reflux in either the supine or the right decubitus position. None of the patients complained of reflux or other dyscrasic symptoms, and none had any feeling of microgastria. One patient had some localized erosion near the anastomosis.
  
  
  CONCLUSIONS
  This simple and safe technique does not result in post-gastrectomy syndrome or microgastria, and the risk of leaving cancer cells is minimal.
authors.affiliation: Departments of Gastroenterological Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 710-0192, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hirai
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Katsumichi
authors.initials: K
authors.lastname: Iki
authors.forename: Yoko
authors.initials: Y
authors.lastname: Hirabayashi
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kawabe
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ikeda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamamura
authors.forename: Shinji
authors.initials: S
authors.lastname: Hato
authors.forename: Atsushi
authors.initials: A
authors.lastname: Urakami
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yamashita
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Tsunoda
authors.forename: Ken
authors.initials: K
authors.lastname: Haruma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000294:innervation / Q000473:pathology*; D049631:Esophageal Sphincter, Upper / Q000294:innervation / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000601:surgery*