Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD

Aburatani, Tomoki; Kojima, Kazuyuki; Otsuki, Sho; Murase, Hideaki; Okuno, Keisuke; Gokita, Kentaro; Tomii, Chiharu; Tanioka, Toshiro; Inokuchi, Mikito

doi:10.1007/s00464-017-5539-4

Cited by 45 publications

(59 citation statements)

References 27 publications

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“…Some studies have shown that LPG with DTR (PG-DT) could be used to avoid anastomotic complications [23,24]. In one study, the incidence of reflux symptoms, usage of proton pump inhibitors, and anastomotic strictures were significantly lower in the DTR than in the EG stomy group [23]. Li et al performed a meta-analysis to compare the use of LPG-DTR and TG for proximal early gastric cancer [25].…”

Section: Introductionmentioning

confidence: 99%

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases

Choi¹,

Choi²,

Ko³

et al. 2020

wiitm

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Introduction: Proximal gastrectomy is an alternative treatment modality for gastric cancer in the upper third of the stomach. Though several reconstruction methods have been introduced, there is no standardization. We investigated the outcomes of laparoscopic proximal gastrectomy with double tract reconstruction (LPG-DTR). Aim: To investigate the outcomes of LPG-DTR. Material and methods: We evaluated 37 patients who underwent curative LPG with DTR between December 2013 and December 2018. Less than half of the proximal stomach was laparoscopically resected. We performed LPG-DTR after resection. Results: A total of 37 patients were included in this study, 25 (70%) of whom were male and 12 (30%) of whom were female. Overall, 31 (83.7%) patients were diagnosed with gastric cancer, 5 (13.5%) with gastrointestinal stromal tumors, and 1 (2.8%) with leiomyoma. There were 3 (9.6%) complications. However, there were no complications of grade 3 or above. We did not observe postoperative mortality or recurrence after surgery. All patients underwent postoperative endoscopic surveillance successfully. None of the patients had postoperative reflux esophagitis or stenosis. The body weight and hemoglobin levels of the patients were lowest 12 months after surgery and gradually increased thereafter. Similarly, their vitamin B 12 levels were lowest 6 months after surgery. However, iron been increased after surgery until 24 months after surgery. Conclusions: LPG-DTR is a favorable treatment modality for gastric cancer in the upper third of the stomach.

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Section: Introductionmentioning

confidence: 99%

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases

Choi¹,

Choi²,

Ko³

et al. 2020

wiitm

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“…However, the risk of reflux esophagitis and anastomotic stenosis is a huge challenge for the widespread use of PG. To improvement these disadvantages, several modified reconstruction procedures, including jejunal interposition, jejunal pounch interposition, double-flap, and double-tract anastomosis, have been attempted [6,[19][20][21]. According to previous studies, PG-DT is one of the most promising procedures, in reducing anastomotic complications (reflux esophagitis and anastomotic stenosis) and improving operative quality of life [7,12].…”

Section: Discussionmentioning

confidence: 99%

“…Some scholars suggested that patients with proximal EGC could be treated with proximal gastrectomy with double-tract reconstruction (PG-DT), to avoid anastomotic complications [6,7]. It was reported that the incidences of reflux symptoms, usage of proton pump inhibitors, and anastomotic strictures 3 were significantly lower in the double-tract anastomosis group as compared to the esophagogastrostomy group [6]. However, a recent multicenter study from the western experience showed that patients who underwent PG have an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture [8].…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

Shen

et al. 2019

Preprint

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Background In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. Methods The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. Results The results showed no significant difference in the anastomotic stenosis (OR=0.91, 95%CI=0.33-2.50, p=0.85) and reflux esophagitis (OR=1.87, 95%CI=0.62-5.65, p=0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR=0.06, 95%Cl=0.01-0.59, p=0.02). Conclusions Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.

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“…Nakamura et al clarified that, in comparison to JI and JPI, EG had benefits of lower invasiveness. Additionally, a host of studies have suggested that DT reconstruction has a lower incidence of postoperative complications than EG has especially reflux esophagitis [36,37]. However, its superiority needs more long-term clinical data to confirm.…”

Section: Gastroenterology Research and Practicementioning

confidence: 99%

Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

Wang

et al. 2020

Gastroenterology Research and Practice

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Background. Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods. A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results. Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P<0.001), 56.58 mL less blood loss (P=0.03), and 7.4 days shorter hospital stay time (P<0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR=0.44, 95%CI=0.20 to 0.97, P=0.04), lower risk of intestinal obstruction (OR=0.07, 95%CI=0.01 to 0.43, P=0.004), and higher risk of reflux esophagitis (OR=2.47, 95%CI=1.07 to 5.72, P=0.03). Conclusion. The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.

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Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD

Abstract: Our results indicate that DTR is a useful reconstruction method after PG, especially in terms of preventing reflux esophagitis and anastomotic strictures.

Cited by 45 publications

References 27 publications

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases

Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases

A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer

Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

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