The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach

Kitamura, Kazuya; Yamaguchi, Toshiharu; Nishida, Satoki; Yamamoto, Kazuhito; Ichikawa, Daisuke; Okamoto, Kazuma; Taniguchi, Hiroki; Hagiwara, Akeo; Sawai, Kiyoshi; Takahashi, Toshio

doi:10.1007/bf02385777

Cited by 35 publications

(22 citation statements)

References 11 publications

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“…Previously, several studies have found no difference in the 5-year survival among patients with proximal gastrectomy and those with total gastrectomy [6,7] . Proximal gastrectomy for early gastric cancer in the upper third of the stomach is an appropriate operation in terms of radical treatment and safety.…”

Section: Discussionmentioning

confidence: 95%

“…After completion of esophagogastrostomy, the left end of the gastric stump was fixed to the diaphragm. Furthermore, the pyloroplasty was done in the standard manner with inter r upted sutures [6][7][8] . To perfor m esophagogastric posterior wall end-to-side anastomosis (EP procedure), the stapler that was inserted into the remnant stomach through the anterior wall, and the center rod of the circular stapler was pierced through the center of the posterior wall.…”

Section: Esophagogastrostomy Procedures and Randomizationmentioning

confidence: 99%

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Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Zhang¹,

Sun²,

Xu³

et al. 2009

WJG

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AIM:To compare postoperative quality of life (QOL) in patients with gastric cancer treated by esophagogastrostomy reconstruction after proximal gastrectomy.METHODS: QOL assessments that included functional outcomes (a 24-item survey about treatmentspecific symptoms) and health perception (Spitzer QOL Index) were performed in 149 patients with gastric cancer in the upper third of the stomach, who had received proximal gastrectomy with additional esophagogastrostomy. RESULTS:Fifty-four patients underwent reconstruction by esophagogastric anterior wall end-to-side anastomosis combined with pyloroplasty (EA group); 45 patients had reconstruction by esophagogastric posterior wall end-to-side anastomosis (EP group); and 50 patients had reconstruction by esophagogastric end-to-end anastomosis (EE group). The EA group showed the best postoperative QOL, such as recovery of body weight, less discomfort after meals, and less heart burn or belching at 6 and 24 mo postoperatively. However, the survival rates, surgical results and Spitzer QOL index were similar among the three groups. CONCLUSION:Postoperative QOL was better in the EA than EP or EE group. To improve QOL after proximal gastrectomy for upper third gastric cancer, the EA procedure using a stapler is safe and feasible for esophagogastrostomy.

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Section: Discussionmentioning

confidence: 95%

Section: Esophagogastrostomy Procedures and Randomizationmentioning

confidence: 99%

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Zhang¹,

Sun²,

Xu³

et al. 2009

WJG

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“…Kaibara et al [13] indicated that none of 90 tumors confined to the upper third of the stomach had metastasis to the pyloric lymph nodes, and the 5-year survival rate after curative resection was not different between proximal and total gastrectomies (57% vs 58%); they concluded that proximal gastrectomy was indicated when the tumor was confined to the upper third of the stomach. Kitamura et al [7] showed that although three tumors invading the serosa had metastatic lymph nodes along the lower part of the stomach, the survival rate was not different between proximal and total gastrectomies; they advocated that proximal gastrectomy should be performed when the tumor invasion was not beyond the muscularis propria.…”

Section: Discussionmentioning

confidence: 99%

“…In contrarst, early cancers in the upper stomach show the same biologic behavior as those in the lower stomach, and surgical results of patients with early-stage upper gastric cancer are excellent [7]. However, to our knowledge, there is no comprehensive study concerning the pathology and outcome of early-stage gastric cancer treated by proximal gastrectomy.…”

Section: Introductionmentioning

confidence: 99%

Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

et al. 1999

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Abstract:Background. The frequency of tumors in the upper one-third of the stomach has been increasing. The standard operation for proximal gastric cancer has been total or proximal gastrectomy. The aim of this study was to present the pathologic and surgical results of 30 patients with early-stage proximal gastric cancer managed by proximal gastrectomy. Methods. A consecutive series of 30 patients who underwent proximal gastrectomy for early-stage proximal gastric cancer was studied. Sixteen patients underwent jejunal interposition, while 14 underwent gastric tube reconstruction, which consisted of a direct anastomosis between the esophagus and the remnant of the tube-like stomach. Results. Twenty patients (67%) had no abdominal symptoms and the lesions were detected by screening gastric fiberscopy. The tumors were mostly located along the lesser curvature (73%), were grossly depressed type (IIc) (70%), and histologically well differentiated type (63%). The depth of wall invasion was the mucosa in 12 patients, submucosa in 15, and muscularis propria in 3; lymph node metastasis was absent in 28 patients (93%). When compared with patients with jejunal interposition, patients with gastric tube reconstruction had a shorter operation time (327 vs 165 min), less blood loss (508 vs 151 g), and shorter hospital stay after operation (31 vs 17 days). Endoscopy and 24-h pH monitoring showed no evidence of reflux esophagitis, except in 1 patient with gastric tube reconstruction, and no patient died of recurrence. Conclusions. Early-stage proximal gastric cancer can be successfully treated by proximal gastrectomy. Since gastric tube reconstruction is a simple, easy, and safe procedure, proximal gastrectomy followed by gastric tube reconstruction is recommended for patients with early-stage proximal gastric cancer. Offprint requests to: Y. Adachi

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“…[1][2][3][4] However, the procedure is complicated and time-consuming, and is sometimes un-toring. Esophageal pH changes were recorded and analyzed with a Digitrapper MK III (Synectics Medical, Stockholm, Sweden) and an EsopHogram (Gastrosoft, Dallas, TX, USA).…”

Section: Introductionmentioning

confidence: 99%

Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy

et al. 1998

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Abstract:Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal twothirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia.

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The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach

Cited by 35 publications

References 11 publications

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction

Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction

Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy

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