Evaluation of jejunal pouch interposition after proximal gastrectomy for early gastric cancer in the upper third of the stomach.
OBJECTIVE
Proximal gastrectomy has two problems, reflux esophagitis and curability. This study evaluates postoperative outcomes focusing on reflux esophagitis and curability of proximal gastrectomy with jejunal pouch interposition for early gastric cancer in the upper third of the stomach.


METHODS
One hundred and thirty nine patients who underwent jejunal pouch interposition between 1996 and 2011, 10 esophago-gastrostomy and 20 jejunal interposition at our institution were compared retrospectively to examine heart burn and reflux esophagitis. Furthermore, we examined the remote outcomes of jejunal pouch interposition patients.


RESULTS
There were significantly fewer cases of heart burn; the numbers of cases of reflux esophagitis based on endoscopic findings were significantly small in jejunal pouch interposition. Carcinoma of the remnant stomach after jejunal pouch interposition was observed in 9 patients, curative treatment was possible with endoscopic therapy in 6 patients and surgical treatment in 3 patients. There are 119 survivals and 20 deaths at present Death caused primary disease is only 2 patients. Both recurrent patterns were peritoneal metastasis and the histopathological diagnosis was not indicated for proximal gastrectomy.


CONCLUSIONS
Jejunal pouch interposition after proximal gastrectomy for early upper third gastric cancer proves beneficial and favorable modality achieving prevention of reflux esophagitis and high curability.
Department of Surgery, Niigata Cancer Center Hospital, Niigata, Japan. yabu@niigata-cc.jp
Hiroshi
H
Yabusaki
Atsushi
A
Nashimoto
Atsushi
A
Matsuki
Masaki
M
Aizawa
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016099:Endoscopy, Gastrointestinal; D004942:Esophagitis, Peptic / Q000209:etiology / Q000517:prevention & control; D004946:Esophagostomy; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000401:mortality; D018530:Gastric Stump / Q000473:pathology; D005774:Gastrostomy; D006356:Heartburn / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000556:secondary; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019738:Surgically-Created Structures; D013997:Time Factors; D016896:Treatment Outcome