Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition.
BACKGROUND
For early gastric cancer located in the upper third of the stomach, we have adopted laparoscopic 1/2-proximal gastrectomy (PG) with two types of reconstruction: double tract reconstruction (L-DT) and jejunal interposition reconstruction with crimping of the jejunum on the anal side of the jejunogastrostomy with a knifeless linear stapler (L-JIP).


METHODS
Functional outcomes were prospectively compared between these two types of reconstruction following laparoscopic PG. Resection and reconstruction were performed using L-DT (n = 10) and L-JIP (n = 10) alternately. Quality of life was evaluated through a questionnaire and endoscopic examination of the ten patients in each group, and functional evaluations were carried out in five patients of each group.


RESULTS
The postoperative/preoperative body weight ratio was significantly higher in the L-JIP group than in the L-DT group. While the incidence of reflux esophagitis was 10% in both groups, the endoscope could reach the remnant stomach in all patients. In the L-DT group, the plasma acetaminophen concentration at 15 minutes and the insulin level at 30 minutes were markedly increased after oral administration, while the increases in the blood sugar level at 30 and 60 minutes were more gradual than in the L-JIP group.


CONCLUSIONS
While L-JIP may be thought of as the ideal method for function-preserving gastrectomy, L-DT may be suitable for gastric cancer patients with impaired glucose tolerance. These results raise the possibility of individualized selection of reconstruction for gastric cancer patients with various kinds of preoperative complications.
Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan. nomura@hachioji-hosp.tokai.ac.jp.
Eiji
E
Nomura
Sang-Woong
SW
Lee
Masaru
M
Kawai
Masashi
M
Yamazaki
Kazuhito
K
Nabeshima
Kenji
K
Nakamura
Kazuhisa
K
Uchiyama
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D010535:Laparoscopy; D008207:Lymphatic Metastasis; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome