Lower esophageal sphincter- and vagus-preserving proximal partial gastrectomy for early cancer of the gastric cardia.
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.
Hirai
Toshihiro
T
Departments of Gastroenterological Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 710-0192, Japan.
Matsumoto
Hideo
H
Iki
Katsumichi
K
Hirabayashi
Yoko
Y
Kawabe
Yukiko
Y
Ikeda
Masaharu
M
Yamamura
Masahiro
M
Hato
Shinji
S
Urakami
Atsushi
A
Yamashita
Kazuki
K
Tsunoda
Tsukasa
T
Haruma
Ken
K
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*