Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer.
BACKGROUND
Proximal gastrectomy is not routinely performed because it is associated with increased reflux symptoms and anastomotic strictures. The purpose of this study is to describe a novel method of laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) for proximal early gastric cancer (EGC), and to evaluate the technical feasibility, safety, and short-term surgical outcomes, especially reflux symptoms, after LPG.


METHODS
Retrospective review of the prospective cohort data of 43 patients who presented to a single tertiary hospital from June 2009 through April 2012 and underwent LPG with DTR for proximal EGC. The data of this prospective cohort were analyzed, and the reflux symptoms, clinicopathologic characteristics, surgical outcomes, postoperative morbidities and mortalities, and follow-up findings were analyzed.


RESULTS
The mean surgical time was 180.7 min; mean estimated blood loss, 120.4 mL; mean length of the proximal resection margin, 4.13 cm; mean number of retrieved lymph nodes, 41.2; and mean postoperative hospital stay, 7.1 days. Early complication rate was 11.6 % (n = 5); major complication (grade higher than Clavien-Dindo IIIa) occurred in 1 patient (2.3 %). Late complication rate was 11.6 % (n = 5): 2 patients had esophagojejunostomy stenosis, which was successfully treated with fluoroscopic balloon dilatations; 1, chylous ascites; and 2 had Visick grade II reflux symptoms (4.6 %), managed by medication during the mean follow-up period of 21.6 months.


CONCLUSIONS
DTR after LPG is a feasible, simple, and novel reconstruction method with excellent postoperative outcomes in terms of preventing reflux symptoms. Its clinical applicability must be validated by prospective randomized trials.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Sang-Hoon
SH
Ahn
Do Hyun
DH
Jung
Sang-Yong
SY
Son
Chang-Min
CM
Lee
Do Joong
DJ
Park
Hyung-Ho
HH
Kim
D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome