Esophagogastric junction cancer successfully treated by laparoscopic proximal gastrectomy and lower esophagectomy with intrathoracic double‐flap technique: A case report

Hosoda, Kei; Yamashita, Keishi; Moriya, Hiromitsu; Washio, Marie; Mieno, Hiroaki; Ema, Akira; Watanabe, Masahiko

doi:10.1111/ases.12419

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Intrathoracic or transhiatal esophagogastrostomy with a double-flapped technique seems to be complicated but has advantageous in terms of reducing anastomotic leakage and preventing reflux esophagitis. A previous case report demonstrated an advantage of transhiatal esophagogastrostomy with a double-flapped technique for EGJC, and the results in the current series also suggested that this technique had actual benefits [36].…”

Section: Discussionsupporting

confidence: 69%

Requiring Multi-Steps During Minimally Invasive Surgery to Achieve Optimal Proximal Resection Margin for Siewert-Types II and III Esophagogastric Junctional Cancer

Uchiyama¹,

Noshirο²,

Iwasaki³

et al. 2019

ACO

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Background: Transection of the esophagus at a cancer-negative proximal surgical margin and alimentary tract reconstruction through the hiatus during minimally invasive surgery (MIS) may be complicated and difficult in some patients with Siewert type II or III esophagogastric junctional cancer (EGJC). In this study, we retrospectively determined requiring multi-steps during MIS for Siewert types II and III EGJC. Study Design: Fifty-one consecutive patients with surgically treated Siewert type II or III EGJC were reviewed from July 2006 to October 2016. Five patients were excluded, and the remaining forty-six patients were divided into four groups based on the combination of laparoscopic and thoracoscopic surgical procedures performed, according to Siewert classification and TNM-staging: one-step surgery (n = 16), twostep surgery without novel transection of the esophagus (n = 8), two-step surgery with novel transection of the esophagus (n = 13), and three-step surgery (n = 9). Results: The esophagus was transected successfully with a cancer-free proximal margin in all but one patient. However, only 16 patients (35 %) were treated successfully by laparoscopic surgery alone, and the remaining 30 patients needed one or more additional steps to complete the anastomosis after transection of the esophagus according to the extent of esophageal invasion of the tumor. Conclusion: Multi-step procedures may be needed to achieve a cancer-negative proximal margin followed by alimentary reconstruction during MIS in patients with Siewert type II or III EGJC.

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Section: Discussionsupporting

confidence: 69%

Requiring Multi-Steps During Minimally Invasive Surgery to Achieve Optimal Proximal Resection Margin for Siewert-Types II and III Esophagogastric Junctional Cancer

Uchiyama¹,

Noshirο²,

Iwasaki³

et al. 2019

ACO

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“…Among them, Tanaka et al used endoscopic ultrasonography to observe cancer cells in a patient with esophagogastric junction cancer, which was successfully removed [6]. Hosoda et al successfully resected patients with esophagogastric junction cancer through endoscopic ultrasonography, where the operation time was shorter than traditional operation and the patients recovered after surgery [7]. Nagami et al indicated that endoscopic ultrasonography has a high guiding significance in preoperative TN staging of esophagogastric junction cancer [8].…”

Section: Introductionmentioning

confidence: 99%

Clinical Comparison of Endoscopic Ultrasonography and CT in Preoperative TN Staging of Esophagogastric Junction Cancer

Peng

Lou

Wang

et al. 2022

Contrast Media & Molecular Imaging

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In recent years, the incidence of esophagogastric junction cancer has increased year by year. It is a special type of gastric cancer, with 80% of patients being clinically in the middle and late stages. The traditional treatment methods are extremely ineffective, and the accuracy of preoperative staging is not good enough. At present, the medical treatment for esophagogastric junction cancer mainly adopts surgery and postoperative adjuvant therapy. The current mainstream clinical diagnostic methods of esophagogastric junction cancer before concurrent neoadjuvant chemoradiotherapy are X-ray, CT examination, and gastroscopic diagnosis. However, these clinical diagnostic methods have many limitations. Endoscopic ultrasonography (EUS) can accurately locate malignant tumors in the digestive tract, surrounding microstructures. It can diagnose lymphatic metastasis so as to provide a clear imaging basis for neoadjuvant chemoradiotherapy. This method can also effectively improve the prognosis of the esophagus and stomach according to the characteristics of the patient. In this experiment, we conducted a controlled trial on patients with stage III esophagogastric junction cancer, divided into an experimental group (neoadjuvant chemotherapy + surgery) and a control group (conventional surgery). The preoperative EUS staging in the control group, the preoperative EUS staging in the neoadjuvant chemoradiotherapy group, and the postoperative pathological staging were compared. The experiment showed that in the control group, the preoperative and postoperative accuracy of EUS was 89.2%, while the preoperative and postoperative accuracy of CT examination was only 62.5%. In the experimental group, the preoperative and postoperative accuracies of EUS and CT were 79.6% and 56.7%, respectively. EUS has both specificity and accuracy due to CT examination. Through studying EUS technology in the staging and diagnosis of esophagogastric junction cancer, the therapeutic effect of esophagogastric junction cancer can be improved. The prognosis of esophagogastric junction cancer can also be improved.

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“…We previously reported the efficacy of DFT in the reconstruction of antireflux mechanisms, in addition to its ease of performance by laparoscopy through standardization of the procedure and proficiency in laparoscopic suturing and ligation techniques . The efficacy of this procedure has also been reported by other institutions, including reporting of the feasibility of intrathoracic DFT . However, these reports are all based on single institution studies with a limited number of cases, raising concerns about its universality.…”

Section: Introductionmentioning

confidence: 99%

Multicenter retrospective study to evaluate the efficacy and safety of the double‐flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD‐FLAP Study)

Kuroda

Choda

Otsuka

et al. 2018

Annals of Gastroent Surgery

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AimAs a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double‐flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single‐center studies with a limited number of cases.MethodsWe conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1‐year after surgery, and secondary endpoint was incidence of anastomosis‐related complications.ResultsOf 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1‐year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra‐thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44‐10.9, P = 0.0109). Total incidence of anastomosis‐related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis‐related complications (OR: 3.93, 95% CI: 1.93‐7.80, P = 0.0003).ConclusionDouble‐flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well‐prepared for.

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Esophagogastric junction cancer successfully treated by laparoscopic proximal gastrectomy and lower esophagectomy with intrathoracic double‐flap technique: A case report

Cited by 9 publications

References 9 publications

Requiring Multi-Steps During Minimally Invasive Surgery to Achieve Optimal Proximal Resection Margin for Siewert-Types II and III Esophagogastric Junctional Cancer

Requiring Multi-Steps During Minimally Invasive Surgery to Achieve Optimal Proximal Resection Margin for Siewert-Types II and III Esophagogastric Junctional Cancer

Clinical Comparison of Endoscopic Ultrasonography and CT in Preoperative TN Staging of Esophagogastric Junction Cancer

Multicenter retrospective study to evaluate the efficacy and safety of the double‐flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD‐FLAP Study)

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