Proximal gastrectomy with anti‑reflux anastomosis for patients with adenocarcinoma of the esophagogastric junction: The simple and safe triangle‑valve technique

Abstract

A simple and safe triangle-valve technique (TVT) was applied in proximal gastrectomy (PG) in order to prevent postoperative gastric reflux among patients with adenocarcinoma of the esophagogastric junction (AEG). The clinical outcomes were evaluated in comparison to those of canonical total gastrectomy (TG). This retrospective study of 74 AEG patients compared two surgical procedures, PG-TVT (n=44) and TG (n=30), in terms of surgical outcomes, postoperative complications and nutritional status. The Reflux Disease Questionnaire (RDQ) was used to evaluate reflux esophagitis, and patients with an RDQ score of ≥12 points were diagnosed with gastroesophageal reflux disease (GERD). The mean operative time was significantly shorter in the PG-TVT group (242.6 min) compared with that in the TG group (288.1 min). The overall postoperative complication rate did not differ significantly between the PG-TVT and TG groups. All the patients were followed up for 6 months, and none developed cancer recurrence in distant organs, gastric remnant, or lymph nodes. The GERD incidence was similar between the PG-TVT and TG groups. The mean levels of total protein and albumin within 6 months were significantly higher in the PG-TVT group compared with those in the TG group after adjustingtthe time effect and the interaction of time and surgical methods. The level of total protein significantly increased within 6 months in the PG-TVT group, but decreased in the TG group. Therefore, PG-TVT has several advantages over TG for patients with AEG, including a shorter operative time and better postoperative nutritional status, whereas the incidence of GERD was found to be similar between the two techniques.

Risk factors for anastomotic leakage after gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a retrospective case-control study

“…For patients with early gastric cancer, total and proximal gastrectomy are associated with similar long-term survival [28][29][30] ; however, some studies have indicated that there is a higher rate of anastomosis-related complications in patients who undergo esophagogastrostomy after proximal gastrectomy compared with Roux-en-Y anastomosis after total gastrectomy. [29][30][31][32] In this study, we observed that patients who underwent esophagogastrostomy had a higher rate of leakage compared with those who underwent Roux-en-Y reconstruction (11.83% vs 8.17%, P < 0.05). Therefore, the type of reconstruction is an independent factor associated with the risk of anastomotic leakage.…”