title: Clinical outcome of lower esophageal sphincter- and vagus-nerve-preserving partial cardiectomy for early gastric cancer of the subcardia.
abstract: BACKGROUND
  No definitive operative method has been established for the treatment of early subcardial gastric cancer. Our newly developed technique involves local resection of the subcardia while preserving the lower esophageal sphincter and vagus nerve. A new fornix is constructed to accept the transposed esophagus.
  
  
  METHODS
  Thirty patients underwent this procedure between July 2003 and December 2010. Continuous gastric pH monitoring was performed immediately after surgery, and esophageal manometry was undertaken 1 month later. Serum total protein, albumin, total cholesterol, cholinesterase, and body mass index (BMI) were recorded every 3 months. Pre- and postoperative oral intake were compared, reflux symptoms were recorded, and reflux esophagitis was assessed by endoscopy after 1 year.
  
  
  RESULTS
  Twenty-five patients (86 %) reported no symptoms of reflux, and 27 (92.8 %) patients could eat 70 % or more of what they had eaten before surgery. Lower esophageal pressures were found to be >10 mmHg in 66.7 % of patients, and the fraction of time that pH <4 was <5 % of the 24-h monitoring period in 70 %. Serum parameters and BMI were unchanged.
  
  
  CONCLUSIONS
  This surgical technique is a useful means of preserving postoperative quality of life after local gastrectomy by preventing reflux and maintaining nutritional status.
authors.affiliation: Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan, h-matsu@med.kawasaki-m.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Haruaki
authors.initials: H
authors.lastname: Murakami
authors.forename: Hisako
authors.initials: H
authors.lastname: Kubota
authors.forename: Masaharu
authors.initials: M
authors.lastname: Higashida
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Hirai
mesh_terms: D002299:Cardia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower; D005471:Fluoroscopy; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D059351:Organ Sparing Treatments; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D014630:Vagus Nerve; D014741:Video Recording