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

Abstract

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.

A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer

“…They reported patients had maximum weight decreases of 10.5% within a year after surgery, but by year 3 their weight was able to increase back to 96.8% of their preoperative weight. In contrast to some of the studies mentioned above Choi et al were able to show that by year 2 serum HGB returned to values higher than those before surgery [ 36 ].…”

Double-tract reconstruction for oesofagocardial gastric cancer: A systematic review

“…There were comparable results in all the studies in terms of tumour recurrence, metastasis, and long-term survival in the patients that underwent DT compared to those who underwent TG with Roux-en-Y reconstruction and reconstructive techniques after PG for Siewert type II and III adenocarcinomas [ 18 , 22 , 37 ].…”

“…Vitamin B12 in the blood reached a minimum after six months and then fluctuated. Moreover, the level of albumin was higher than the preoperative level six months after surgery [ 37 ].…”

Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

“…In actual clinical work, this approach might lead to a more satisfying medical experience and save medical resources. In previously reported studies, the morbidity rate of LPG with DTR ranged from 9.6% to 32.3% [ 6 , 24 – 26 ]. In our study, the rate of complications was 21.7% in the LPG group, the same as that in the OPG group (20.3%).…”