Wonho Han, Bang Wool Eom, Hong Man Yoon, Junsun Ryu, Young-Woo Kim. National Cancer Center
Objective: Aim of this study was to show early clinical outcome compared with previous proximal gastrectomy (PG) cases.
Background: PG has been performed as function-preserving surgery in proximally located early gastric cancer. As gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall and the proximal part of the anterior stomach wall to produce an anti-reflux mechanism and named it as SPADE operation.
Methods: A total of 56 patients who underwent PG from January 2012 to March 2018 were retrospectively reviewed. Thirty patients underwent conventional esophagogastrostomy (CEG) anastomosis using circular stapler. Twenty-six patients underwent the SPADE operation. Early postoperative clinical outcomes related reflux symptoms, endoscopic findings and postoperative complications were compared as a case–control study.
Results: Follow-up endoscopy showed more frequent reflux esophagitis in the CEG group than in the SPADE group (30% vs 15.3% p = 0.19). Bile reflux was higher in the CEG group (26.7% vs 7.7% p = 0.08) and residual food was also higher in the CEG group in endoscopic finding with statistical significance (p = 0.01).
In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while three patients had severe symptoms. In the SPADE group, three patients had mild reflux symptoms (11.5%), while one had severe symptoms without statistical significance (absolute difference 31.8%, 95% Cl 1.11 – 29.64, p= 0.01).
Conclusion: A novel modified EG called SPADE operation showed potential in reducing gastroesophageal reflux in PG.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94954
Program Number: P500
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster