title: Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life.
abstract: Proximal gastrectomy is not widely performed because the procedure is complicated, particularly under laparoscopy. We developed a simple laparoscopic technique of hand-sewn esophagogastrostomy with an anti-reflux mechanism. This study aimed to evaluate and compare the postoperative body weight loss (BWL) and quality of life (QOL) following laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) in patients with upper gastric cancer.
  
  
  
  We retrospectively analyzed patients with stage I upper gastric cancer undergoing LPG or LTG at Kyoto University Hospital between March 2006 and June 2014. The main outcome measures were the % BWL 1 year after gastrectomy, postoperative anastomotic stricture, and reflux esophagitis. Additionally, patient-reported outcomes were evaluated using the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45 in patients presenting at the outpatient clinic and exhibiting no recurrence.
  
  
  
  A total of 62 patients were included in this study (LTG, n = 42 vs. LPG, n = 20). The % BWL at 12 months in the LPG group was less than that in the LTG group (-16.3 vs. -10.7%). Multivariate analysis revealed that LPG was associated with less BWL (P = 0.003). Anastomotic stricture occurred more frequently in the LPG group than in the LTG group (0 vs. 25%). One patient in each group exhibited grade B severity of reflux esophagitis (based on the Los Angeles classification). In the questionnaire survey, LPG was better than LTG in terms of diarrhea and dissatisfaction with symptoms. In terms of reflux symptoms, patients in the LPG group experienced less acid and bile regurgitation symptoms compared with those in the LTG group.
  
  
  
  LPG with hand-sewn esophagogastrostomy results in less postoperative BWL and better QOL than LTG despite higher rates of anastomotic stricture.
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tatsuto
authors.initials: T
authors.lastname: Nishigori
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. hokabe@kuhp.kyoto-u.ac.jp.|Department of Surgery, Otsu Municipal Hospital, 2-9-9, Motomiya, Otsu City, Shiga Prefecture, 520-0804, Japan. hokabe@kuhp.kyoto-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Okabe
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Tsunoda
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Shinohara
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Obama
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Hosogi
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shigeo
authors.initials: S
authors.lastname: Hisamori
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Kikuko
authors.initials: K
authors.lastname: Miyazaki
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
authors.affiliation: Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Sakai
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Body weight changes; Laparoscopy; Proximal gastrectomy; Quality of life; Stomach neoplasms; Total gastrectomy