Reconstruction Methods and Complications in Proximal Gastrectomy for Gastric Cancer, and a Comparison with Total Gastrectomy

Abstract

Proximal gastrectomy (PG) is a widely accepted, efficient treatment for upper-third early gastric cancer. However, it is associated with reduced quality of life (QOL) following surgery, and cancer recurrence in the remaining stomach. Various reconstruction methods have been proposed, but the optimal method has yet to be determined. We investigated the clinicopathological characteristics, reconstruction methods, and postoperative complications in 101 cases of PG, and additionally compared 93 cases of early gastric cancer treated by PG, and 38 cases treated by total gastrectomy (TG). We found that esophagogastrostomy was superior in terms of operation time, intraoperative blood loss, and postoperative hospital stay, while no significant differences were observed in postoperative complications compared with jejunal interposition or jejunal pouch interposition. We found more cases of multiple gastric cancers and advanced-stage cancer in the TG group than in the PG group. The TG group also had a significantly higher proportion of cases with large tumor diameters, low degrees of differentiation, many lymph node metastases, and advanced-stage disease. There were no differences in the recurrence rate or survival rate between the PG and TG groups. The PG group also showed significantly better results in operating time, intraoperative blood loss, and postoperative complications, with a tendency toward shorter hospital stays. In conclusion, PG is a curative but less invasive treatment for upper-third early gastric cancer, and esophagogastrostomy can be considered the most satisfactory reconstruction method following PG.

Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis

“…The qualitative studies included 8 studies comparing JI VS JPI and JI VS EG after proximal gastrectomy. All the studies included are from japan: Yasuda et al [32], kameyama et al [21], isobe et al [27], and Kazuhiro et al [28], tokunaga et al, nakamura et al, masuzawa et al, and Senmaru et al [26]. Studies for analysis included operative time, blood loss and hospital length of stay, reflux esophagitis, anastomotic stricture, and anastomotic leakage as shown in Table 3.…”

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

“…A total of 3,194 studies were reviewed in our search (see Figure 1), and 2,114 articles were excluded because they were not relevant. Finally, we included eight relevant articles [10][11][12][13][14][15][16][17] with a total of 496 patients. Depending on NOS criteria, three studies were retrospective with medium risk of bias and five studies were considered high quality with low risk of bias (see Table 1).…”

“…Final check was confirmed by the corresponding author. The data included the following parameters: operating time [10][11][12][13][14], blood loss [10][11][12][13][14], hospital stays [11][12][13][14], anastomotic leakage [11,12,[14][15][16][17], anastomotic stenosis [11][12][13][14][15][16][17], intestinal obstruction [11,12,17], and reflux esophagitis [10][11][12][14][15][16][17].…”

Novel Reconstruction Using Roux-en-Y Plus Antral Obstruction Following Proximal Gastrectomy: Feasibility and Quality of Life Benefits

“…To overcome these problems, sphincterotomy and pyloroplasty have become common practices following esophagogastric anastomosis and have reduced the incidence of gastric emptying dysfunction. Nevertheless, due to destruction of the cardiac and pyloric structures, reflux of not only bile into the stomach but also gastric contents into the esophagus occurs, and because the incidence of reflux is not significantly reduced, postoperative quality of life is not significantly improved [26][27][28][29].…”