T Kubota, PhD1, H Idani, PhD1, S Miyake, MD1, M Ishida, PhD1, Y Choda, MD1, S Shiozaki, PhD1, M Okajima, PhD1, Motoki Ninomiya2. 1Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 2Departmrnt of surgery, Hiroshima Memorial Hospital
BACKGROUND: Proximal gastrectomy (PG) is indicated for gastric cancer located at the upper third of the stomach or esophagogastric junction (EGJ) to preserve gastric function. However, gastroesophageal reflux (GER) is a serious problem after surgery. We have introduced esophagogastrostomy with double-flap technique (DFT) during laparoscopic proximal gastrectomy (LAPG) to avoid GER, and evaluated the outcome.
SURGICAL TECHNIQUES: Reconstruction by DFT in LAPG: After the stomach was resected, the remnant stomach was withdrawn from the upper abdominal incision and a H-shaped double seromuscular flap (3.5 cm × 2.5 cm) was made by dissecting between submucosal and muscular layers at the anterior remnant gastric wall. After creation of the double flap, the posterior esophageal wall (5cm from the edge) and the anterior gastric wall (superior edge of the mucosal window) were sutured for fixation, and 1.0 cm from the inferior edge of the mucosal window was opened, and the wall of the esophageal edge and the opening of the remnant gastric mucosa were sutured continuously. The anastomosis was fully covered by the seromuscular flaps with suturing.
In LATG, Roux-en-Y reconstruction was performed through a small incision using a circular stapler.
METHODS: From 2006 to 2014, 72 patients with early gastric cancer (T1) located at the upper third of the stomach or EGJ underwent LAPG (n = 51) or LATG (n = 21). The type of surgery was selected by the surgeon’s preference. Clinical outcome and postoperative nutritional status were evaluated. As evaluation of nutritional status, body mass index (BMI) and psoas muscle index (PMI) which was calculated at the umbilical level by CT scan were used.
RESULTS: The operative time of LAPG tended to be longer than LATG (358 vs. 298 min N.S.). The morbidity of LAPG tended to be lower than LATG (7.8 vs. 23.8%). LA classification Grade B or more severe reflux esophagitis was observed in 2 of LAPG (3.9%) and in 1 of LATG (4.8%). The reduction of BMI and PMI of patients undergoing LAPG were significantly prevented three years after the operation compared to those undergoing LATG (BMI 6.1% vs 19.1%: p=0.021, PMI 7.3% vs 20.9%: p<0.001).
CONCLUSION: LAPG reconstructed with double flap technique prevents postoperative GER and better clinical and nutritional outcome, and should be considered instead of LATG for patients with early gastric cancer (T1) located at the upper third of the stomach or EGJ.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87178
Program Number: P462
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster