title: Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis.
abstract: OBJECTIVE
  This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC).
  
  
  METHODS
  The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups.
  
  
  RESULTS
  The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001).
  
  
  CONCLUSIONS
  Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yeon-Ju
authors.initials: YJ
authors.lastname: Huh
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyuk-Joon
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seung-Young
authors.initials: SY
authors.lastname: Oh
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Surgery, Myongji Hospital, Goyang, Korea.
authors.forename: Kyung-Goo
authors.initials: KG
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea.
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hye-Seong
authors.initials: HS
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yun-Suhk
authors.initials: YS
authors.lastname: Suh
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Kong
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Department of Surgery, Myongji Hospital, Goyang, Korea.
authors.forename: Kuhn-Uk
authors.initials: KU
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; Cancer Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Han-Kwang
authors.initials: HK
authors.lastname: Yang
keywords: Gastrectomy; Laparoscopy; Stomach neoplasms