Comparative Study of Clinical Outcomes between Laparoscopic Proximal Gastrectomy with Double-Tract Reconstruction and Laparoscopic Total Gastrectomy for Proximal Gastric Cancer

Ki-Hyun Kim, Do Hyun Jung, Sang-Yong Son, Young-Suk Park, Dong Joon Shin, Sang-Hoon Ahn, Do Joong Park, Hyung-Ho Kim. Seoul National University Bundang Hospital, Seoul National University College of Medicine

Background)
Proximal gastrectomy (PG) is not routinely performed because it is associated with increased reflux symptoms. Double-tract reconstruction (DTR) has been known to reduce reflux esophagitis for PG patients. The aim of this study was to compare the clinical outcomes of patients who underwent Laparoscopic PG (LPG) with DTR with those treated by laparoscopic total gastrectomy (LTG).
Methods)
Data on 51 cases of LPG with DTR and 121 cases of LTG with Roux-Y reconstruction for proximal early gastric cancer were analyzed retrospectively in terms of short-term, long-term, and functional outcomes (nutritional status and anemia).
Results)
There were no significant differences in demographics, T-stage, N-stage, estimated blood loss, or recurrence rate between the 2 groups. The LPG with DTR group had a shorter operative time than the LATG group (182.06 vs. 222.36 min, P = 0.001). The early complication rates after the LPG and LTG procedures were 13.7% and 25.6%, respectively (p = 0.108). The parameters that reflected nutritional status were similar in the 2 groups at the first and second year. However, LPG group had a significantly better hemoglobin levels than LTG group at the first and second year (1st year 13.52 vs. 12.89 g/? p = 0.007, 2nd year 13.46 vs. 12.86 g/? p = 0.038). The incidence of reflux symptoms more than Visick grade II was not significantly different in the 2 groups during the mean follow-up period of 41.2 months (2.0% vs. 4.1%, p = 0.671).
Conclusion)
LPG with DTR maintains comparable oncological radicality to LTG and is preferred over LTG in terms of preventing postoperative anemia.