Feasibility and functional outcomes of laparoscopic proximal gastrectomy with double tract reconstruction for proximal gastric cancer: comparative study with conventional laparoscopic total gastrectomy

Young Kyu Park, PhD, Mi Ran Jung, PhD, Seong Yeob Ryu, PhD, Oh Jeong, PhD. Chonnam National university Hwasun Hospital

Introduction: Laparoscopic proximal gastrectomy (LPG) with double tract reconstruction (DTR) is an attractive treatment option for proximal gastric cancer when considering the advantages of a function preservation, including improved nutrition and a decreased incidence of postopertive reflux esophagitis. The aim of this study was to assess the feasibility of LPG with DTR and to compare the functional outcomes of LPG with laparoscopic total gastrectomy (LTG).

Methods: Between November 2011 and August 2015, 158 patients with proximal gastric cancer underwent LPG (n=24) or LTG (n=134) at our institution. Patients were indicated for LPG if they were diagnosed with cT1N0M0 and LTG was indicated for the patients with cT1N0, T1N1 and T2N0 gastric cancer. We reviewed their medical records from our prospectively collected gastric cancer database. The clinicopathological characteristics and functional outcomes were compared between two groups.

Results: There was no significant differences in demographic and pathologic characteristics. Though the operative time was longer in LPG group (303±54 vs. 262±78 min, p=0.013), the postoperative 30-days complication rate was not significantly different between two groups (20.8% vs. 16.4%, p=0.565). The incidences of endoscopic findings of reflux esophagitis (0% vs. 3.7%, p=1.000) and reflux symptoms (4.8% vs. 10.9%, p=0.694) were similar in both groups. LPG group had a significantly better serum Vitamine B12 levels at the first postoperative year than LTG group(420±289 vs. 253±133, p=0.028). The body weight loss during postoperative 1 year was also significantly lower in LPG group (6.4±3.3 vs. 8.7±4.5 kg, p=0.023).

Conclusion: In the study, the LPG with DTR is a technically feasible and showed comparable incidence of postoperative reflux esophagitis to the LTG. Moreover, LPG is preferred over LTG in terms of postoperative nutritional status at first year. Therefore, LPG with DTR would be a good alternative procedure for proximal gastric cancer. A large scaled randomized trial is needed to validate the functional benefits of LPG.