Daisuke Ichikawa, MD, Yoshihiko Kawaguchi, MD, Hienori Akaike, MD, Yuki Nakata, MD, Mitsuaki Watanabe, MD, Naohiro Hosomura, MD, Hideya Amemiya, MD, Hiromitsu Kawaida, MD, Makoto Sudoh, MD, Hiroshi Kohno, MD. University of Yamanashi
INTRODUCTION: Recently, the frequency of early gastric cancer in the upper third of the stomach has especially increased. We report here our recent laparoscopic procedure of esophagogastrostomy after limited proximal gastrectomy (LPG) for the treatment of upper third early gastric cancer.
METHODS and PROCEDURES: Key points of our procedure are as follows; 1)Preservation of hepatic and pyloric branches of vagal nerve, 2)Preservation of intra-abdominal esophagus as much as possible, 3)End-to-side esophago-gastrostomy on the anterior wall, 2cm from the lesser curvature and 3cm from the top of the remnant stomach, using he circular stapler, 4)Seromuscular anchoring suture between the intra-abdominal stomach and the top of the remnant stomach, 5)Anchoring of the remnant stomach to the right crus of diaphragm. We evaluated postoperative clinical results of the patients after LPG.
RESULTS: Our procedure technique preserved peristalsis of the entire length of the esophagus and lower third of the stomach, and allowed the greater curvature near the top of the stomach to function as a new fundus. Lumen of the lower esophagus was closed under normal condition and relaxed after swallowing. There was neither anastomotic leakage nor abdominal abscess. There was little reflux esophagitis on endoscopic examination. Postoperative change of hemoglobin levels and body weights were significantly less in the proximal gastrectomy group than in the total gastrectomy group.
CONCLUSIONS: Our procedure is a simple and easy technique, and may be a better choice for early gastric cancer in the upper-third stomach than laparoscopic proximal gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87492
Program Number: P413
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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