Laparoscopy-Assisted proximal gastrectomy for proximal early gastric cancer (EGC): Novel method for preventing reflux esophagitis.

Sang-Hoon Ahn, MD, Do Joong Park, MD, PhD, Sang-Yong Son, MD, Chang-Min Lee, MD, Ju Hee Lee, MD, Hyung-Ho Kim, MD, PhD

Seoul National University Bundang Hospital

Objective: To describe a novel method of laparoscopy-assisted proximal gastrectomy (LAPG) with double tract reconstruction (DTR) for proximal early gastric cancer (EGC), and to evaluate the technical feasibility, safety, and short-term surgical outcomes, especially reflux symptoms, after LAPG.

Summary Background Data: LAPG is not routinely performed because it is associated with increased reflux symptoms and anastomotic strictures. However, use of DTR with LAPG may abate these adverse effects.

Methods: From June 2009 through April 2012, 43 patients with proximal EGC underwent LAPG with DTR. The data of this prospective cohort were analyzed, and the reflux symptoms, clinicopathologic characteristics, surgical outcomes, postoperative morbidities and mortalities, and follow-up findings were analyzed.

Results: The mean surgical time was 180.7 minutes; mean estimated blood loss, 120.4 mL; mean length of the proximal resection margin, 4.13 cm; mean number of retrieved lymph nodes, 41.2; and mean postoperative hospital stay, 7.1 days. Early complication rate was 11.6% (n = 5); major complication (grade higher than Clavien-Dindo IIIa) occurred in 1 patient (2.3%). Late complication rate was 11.6% (n = 5): 2 patients had esophagojejunostomy stenosis, which was successfully treated with fluoroscopic balloon dilatations; 1, chylous ascites; and 2 had Visick grade II reflux symptoms, managed by medication during the mean follow-up period of 21.6 months.

Conclusion: DTR after LAPG is a feasible, simple, and novel reconstruction method with excellent postoperative outcomes in terms of preventing reflux symptoms. Its clinical applicability must be alidated by prospective randomized trials.

Keywords : Gastric cancer, Laparoscopy, Proximal gastrectomy, Laparoscopy-assisted proximal gastrectomy (LAPG), Double tract reconstruction (DTR), Proximal EGC

Session: Poster Presentation

Program Number: P238

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