Top

European Surgery

Published in:

15-06-2023 | Adenocarcinoma of the Esophagogastric Junction | original article

A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study

Authors: Yongshun Gao, Jiangang Sun, Peng Chen

Published in: European Surgery | Issue 5-6/2023

Summary

Background

Total gastrectomy has been performed for adenocarcinoma of the esophagogastric junction (AEG) because of severe gastro-esophageal reflux (GER) after classic esophago-gastrostomy. Thus, we applied a novel esophago-gastrostomy with anti-reflux triangle-valve (EGAT) in Siewert type II/III AEG patients to prevent postoperative GER.

Methods

This was a three-year retrospective cohort study. We followed 144 Siewert type II/III AEG patients who underwent EGAT (n = 73) and total gastrectomy (TG, n = 71) at our hospital. We analyzed the incidence of postoperative nutritional (hemoglobin, protein levels, and weight) and reflux esophagitis in the two groups. Finally, we conducted a survival analysis was performed.

Results

The average operation time was significantly lower in the EGAT group than in the TG group. However, no significant differences were detected for postoperative complications between the two groups. Postoperative nutritional indexes, including albumin and prealbumin, were significantly higher in the EGAT group than in the TG group six months after surgery. Moreover, we evaluated the hemoglobin one year after surgery, and total protein and body weight after two years of surgery were significantly higher in the EGAT group compared to the TG group. Further, the reflux esophagitis follow-up did not differ (p > 0.05). Finally, no significant difference was detected in the 3‑year overall survival rate between the two groups of patients (p = 0.519).

Conclusion

EGAT is simple and can prevent GER in Siewert type II/III AEG patients.

Available only for authorised users

Wang S, Chen Y, Zhang H, Liang Z, Bu J. The value of predicting human epidermal growth factor receptor 2 status in adenocarcinoma of the esophagogastric junction on CT-based radiomics nomogram. Front Oncol. 2021;11:707686. https://doi.org/10.3389/fonc.2021.707686.CrossRefPubMedPubMedCentral

Reid BJ, Li X, Galipeau PC, Vaughan TL. Barrett’s oesophagus and oesophageal adenocarcinoma: time for a new synthesis. Nat Rev Cancer. 2010;10:87–101. https://doi.org/10.1038/nrc2773.CrossRefPubMedPubMedCentral

Cheng J, Xie Z, Wang S, Wen S, Niu S, Shi C, Yu L, Xu X. Cough hypersensitivity in patients with metabolic syndrome: a clinical finding and its possible mechanisms. BMC Pulm Med. 2021;21:284. https://doi.org/10.1186/s12890-021-01652-x.CrossRefPubMedPubMedCentral

Wang B, Wu Y, Wang H, Zhang H, Wang L, Zhang Z. Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction. BMC Surg. 2020;20:230. https://doi.org/10.1186/s12893-020-00894-6.CrossRefPubMedPubMedCentral

Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol. 2017;23:8553–61. https://doi.org/10.3748/wjg.v23.i48.8553.CrossRefPubMedPubMedCentral

von Rahden BH, Kircher S, Lazariotou M, Reiber C, Stuermer L, Otto C, Germer CT, Grimm M. LgR5 expression and cancer stem cell hypothesis: clue to define the true origin of esophageal adenocarcinomas with and without Barrett’s esophagus? J Exp Clin Cancer Res. 2011;30:23. https://doi.org/10.1186/1756-9966-30-23.CrossRef

Yamashita H, Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg. 2011;254:274–80. https://doi.org/10.1097/SLA.0b013e3182263911.CrossRefPubMed

Liu BW, Liu Y, Liu JR, Feng ZX. Comparison of hand-sewn and stapled anastomoses in surgeries of gastrointestinal tumors based on clinical practice of China. World J Surg Oncol. 2014;12:292. https://doi.org/10.1186/1477-7819-12-292.CrossRefPubMedPubMedCentral

Yang C, Shi Y, Xie S, Chen J, Zhao Y, Qian F, Hao Y, Tang B, Yu P. Short-term outcomes of robotic- versus laparoscopic-assisted total gastrectomy for advanced gastric cancer: a propensity score matching study. BMC Cancer. 2020;20:669. https://doi.org/10.1186/s12885-020-07160-1.CrossRefPubMedPubMedCentral

10.

Zheng Z, Liu X, Xin C, Zhang W, Gao Y, Zeng N, Li M, Cai J, Meng F, Liu D, Zhang J, Yin J, Zhang J, Zhang Z. A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach. BMC Surg. 2021;21:361. https://doi.org/10.1186/s12893-021-01356-3.CrossRefPubMedPubMedCentral

11.

Ota K, Takeuchi T, Kojima Y, Sugawara N, Nishida S, Iwatsubo T, Kawaguchi S, Harada S, Tokioka S, Higuchi K. Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease (ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD‑G including 15 cases followed more than 5 years. BMC Gastroenterol. 2021;21:432. https://doi.org/10.1186/s12876-021-02022-x.CrossRefPubMedPubMedCentral

12.

Cho JH. Reflux following esophagectomy for esophageal cancer. Korean J Thorac Cardiovasc Surg. 2020;53:217–21. https://doi.org/10.5090/kjtcs.2020.53.4.217.CrossRefPubMedPubMedCentral

13.

Huh YJ, Lee HJ, Oh SY, Lee KG, Yang JY, Ahn HS, Suh YS, Kong SH, Lee KU, Yang HK. Clinical outcome of modified laparoscopy-assisted proximal gastrectomy compared to conventional proximal gastrectomy or total gastrectomy for upper-third early gastric cancer with special references to postoperative reflux esophagitis. J Gastric Cancer. 2015;15:191–200. https://doi.org/10.5230/jgc.2015.15.3.191.CrossRefPubMedPubMedCentral

14.

Khalayleh H, Kim YW, Man Yoon H, Ryu KW, Kook MC. Evaluation of lymph node metastasis among adults with gastric adenocarcinoma managed with total gastrectomy. JAMA Netw Open. 2021;4:e2035810. https://doi.org/10.1001/jamanetworkopen.2020.35810.CrossRefPubMedPubMedCentral

15.

Li Z, Dong J, Huang Q, Zhang W, Tao K. Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study. World J Surg Oncol. 2019;17:209. https://doi.org/10.1186/s12957-019-1762-x.CrossRefPubMedPubMedCentral

16.

Ri M, Kumagai K, Namikawa K, Atsumi S, Hayami M, Makuuchi R, Ida S, Ohashi M, Sano T, Nunobe S. Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? Ann Gastroenterol Surg. 2021;5:767–75. https://doi.org/10.1002/ags3.12486.CrossRefPubMedPubMedCentral

17.

Saze Z, Kase K, Nakano H, Yamauchi N, Kaneta A, Watanabe Y, Hanayama H, Hayase S, Momma T, Kono K. Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer. BMC Surg. 2021;21:392. https://doi.org/10.1186/s12893-021-01390-1.CrossRefPubMedPubMedCentral

18.

Gao Y, Sun J, Chen Y, Zhang Y, Chen P, Zong L, Huang J, Han J, Chen X. Proximal gastrectomy with anti-reflux anastomosis for patients with adenocarcinoma of the esophagogastric junction: the simple and safe triangle-valve technique. Mol Clin Oncol. 2020;13:62. https://doi.org/10.3892/mco.2020.2132.CrossRefPubMedPubMedCentral

19.

Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23. https://doi.org/10.1007/s10120-011-0042-4.CrossRef

20.

In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol. 2017;24:3683–91. https://doi.org/10.1245/s10434-017-6078-x.CrossRefPubMed

21.

Shaw M, Dent J, Beebe T, Junghard O, Wiklund I, Lind T, Johnsson F. The reflux disease questionnaire: a measure for assessment of treatment response in clinical trials. Health Qual Life Outcomes. 2008;6:31. https://doi.org/10.1186/1477-7525-6-31.CrossRefPubMedPubMedCentral

22.

Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80. https://doi.org/10.1136/gut.45.2.172.CrossRefPubMedPubMedCentral

23.

Trung LV, Loc NVV, Tien TPD, Vuong NL. Laparoscopic proximal gastrectomy with jejunal interposition for early proximal gastric cancer. J Gastrointest Cancer. 2021;52:536–41. https://doi.org/10.1007/s12029-020-00420-0.CrossRefPubMed

24.

Ji X, Jin C, Ji K, Zhang J, Wu X, Jia Z, Bu Z, Ji J. Double tract reconstruction reduces reflux esophagitis and improves quality of life after radical proximal gastrectomy for patients with upper gastric or esophagogastric adenocarcinoma. Cancer Res Treat. 2021;53:784–94. https://doi.org/10.4143/crt.2020.1064.CrossRefPubMed

25.

Shoji Y, Nunobe S, Ida S, Kumagai K, Ohashi M, Sano T, Hiki N. Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer. Gastric Cancer. 2019;22:1036–43. https://doi.org/10.1007/s10120-019-00940-0.CrossRefPubMed

26.

Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer. 2014;17:562–70. https://doi.org/10.1007/s10120-013-0303-5.CrossRefPubMed

27.

Hosoda K, Washio M, Mieno H, Moriya H, Ema A, Ushiku H, Watanabe M, Yamashita K. Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study. Langenbecks Arch Surg. 2019;404:81–91. https://doi.org/10.1007/s00423-018-1743-5.CrossRefPubMed

28.

Omori T, Yamamoto K, Yanagimoto Y, Shinno N, Sugimura K, Takahashi H, Yasui M, Wada H, Miyata H, Ohue M, Yano M, Sakon M. A novel valvuloplastic esophagogastrostomy technique for laparoscopic transhiatal lower esophagectomy and proximal gastrectomy for Siewert type II esophagogastric junction carcinoma-the tri double-flap hybrid method. J Gastrointest Surg. 2021;25:16–27. https://doi.org/10.1007/s11605-020-04547-0.CrossRefPubMed

29.

Wang L, Xia Y, Jiang T, Li F, Wang W, Zhang D, Xu H, Yang L, Xu Z. Short-term surgical outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy for adenocarcinoma of esophagogastric junction: a matched-cohort study. J Surg Res. 2020;246:292–9. https://doi.org/10.1016/j.jss.2019.09.022.CrossRefPubMed

30.

Yamashita Y, Yamamoto A, Tamamori Y, Yoshii M, Nishiguchi Y. Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy. Gastric Cancer. 2017;20:728–35. https://doi.org/10.1007/s10120-016-0674-5.CrossRefPubMed

31.

Hosogi H, Sakaguchi M, Yagi D, Onishi R, Hashimoto Y, Sakai Y, Kanaya S. Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction. Langenbecks Arch Surg. 2021; https://doi.org/10.1007/s00423-021-02377-5.CrossRefPubMed

32.

Zhang H, Sun Z, Xu HM, Shan JX, Wang SB, Chen JQ. Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction. World J Gastroenterol. 2009;15:3183–90. https://doi.org/10.3748/wjg.15.3183.CrossRefPubMedPubMedCentral

33.

Shiraishi N, Hirose R, Morimoto A, Kawano K, Adachi Y, Kitano S. Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy. Gastric Cancer. 1998;1:78–9. https://doi.org/10.1007/s101209800023.CrossRefPubMed

34.

Takiguchi S, Hiura Y, Miyazaki Y, Takata A, Murakami K, Doki Y. Clinical trial of ghrelin synthesis administration for upper GI surgery. Methods Enzymol. 2012;514:409–31. https://doi.org/10.1016/B978-0-12-381272-8.00026-X.CrossRefPubMed

35.

Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60. https://doi.org/10.1038/45230.CrossRefPubMed

36.

Lim CH, Kim SW, Kim WC, Kim JS, Cho YK, Park JM, Lee IS, Choi MG, Song KY, Jeon HM, Park CH. Anemia after gastrectomy for early gastric cancer: long-term follow-up observational study. World J Gastroenterol. 2012;18:6114–9. https://doi.org/10.3748/wjg.v18.i42.6114.CrossRefPubMedPubMedCentral

Title: A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study
Authors: Yongshun Gao
Jiangang Sun
Peng Chen
Publication date: 15-06-2023
Publisher: Springer Vienna
Keywords: Adenocarcinoma of the Esophagogastric Junction
Gastroesophageal Junction Cancer
Gastrectomy
Gastrectomy
Gastrostomy
Esophagitis
Gastric Cancer
Gastric Cancer
Published in: European Surgery / Issue 5-6/2023
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-023-00806-x

2024 ASCO Annual Meeting

Springer Medicine

A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study

Summary

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Summary

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 5-6/2023

Lymphatic node dissection in liver resection for colorectal metastasis

A modified Rives–Stoppa technique with composite mesh (FLaPp) in large incisional hernia: a multicentric retrospective cohort study

Unraveling the impact of interval length between neoadjuvant chemoradiotherapy and surgery on perioperative and postoperative complications in rectal cancer patients

Comparison of conventional right colectomy and complete mesocolic excision technique—case–control analysis of short-term results

Surgery assists cleaning the roots