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01-03-2014 | Original Article

Esophagogastrostomy Plus Gastrojejunostomy: A Novel Reconstruction Procedure after Curative Resection for Proximal Gastric Cancer

Authors: Shicai Chen, Jianchang Li, Haiying Liu, Jun Zeng, Guohua Yang, Jin Wang, Weiqun Lu, Nanrong Yu, Zhiliang Huang, Houwei Xu, Xiang Zeng

Published in: Journal of Gastrointestinal Surgery | Issue 3/2014

Abstract

Objective

The choice of surgical strategy for patients with proximal gastric cancer remains controversial. In this study, we recommend that a new reconstruction procedure be performed following proximal gastrectomy.

Methods

We conducted a retrospective study involving 71 patients who underwent gastrectomy for proximal gastric cancer. Clinicopathological features, postoperative complications, nutritional status, and overall survival (OS) rate were compared among three different reconstruction approaches.

Results

There were 34 cases of proximal gastrectomy followed by esophagogastrostomy reconstruction (EG), 16 cases of total gastrectomy and Roux-en Y reconstruction (RY) and 21 cases of proximal gastrectomy followed by esophagogastrostomy plus gastrojejunostomy reconstruction (EGJ). Though the clinicopathological features, the nutritional status and OS rate were similar among the three groups of patients, the incidence of reflux esophagitis was significantly higher in the EG group (35.3 %) than the RY (6.2 %) and EGJ (9.6 %) groups(P < 0.05). Few EGJ patients suffered from either reflux esophagitis or anastomotic stenosis.

Conclusions

The EGJ reconstruction method helps to resolve the syndrome of reflux esophagitis. Our data indicates that it is a simple, safe, and effective reconstruction procedure for PGC.

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011; 61: 69–90.PubMedCrossRef

Dolan K, Sutton R, Walker SJ, Morris AI, Campbell F, Williams EM. New classification of oesophageal and gastric carcinomas derived from changing patterns in epidemiology. Br J Cancer 1999; 80: 834–842.PubMedCentralPubMedCrossRef

Harrison LE, Karpeh MS, Brennan MF. Proximal gastric cancers resected via a transabdominal-only approach. Results and comparisons to distal adenocarcinoma of the stomach. Ann Surg 1997; 225:678–683.PubMedCrossRef

Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol 2006; 12: 354–362.PubMed

Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery 1998; 123: 127–130.PubMedCrossRef

Humphrey CS, Johnston D, Walker BE, Pulvertaft CN, Goligher JC. Incidence of dumping after truncal and selective vagotomy with pyloroplasty and highly selective vagotomy without drainage procedure. Br Med J 1972; 3: 785–788.PubMedCentralPubMedCrossRef

Eckhauser FE, Colletti LM, Hasler WL. Postgastrectomy syndromes and motility disorders. In: Bell, R H, Rikkers, L F, Mulholland, M W (eds). Digestive Tract Surgery: a Text and Atlas. Philadelphia: Lippincott-Raven Publishers, 1996, pp201-222.

Mason RJ, DeMeester TR. Importance of duodenogastric reflux in the surgical outpatient practice. Hepato-Gastroenterology 1999; 46: 48–53.PubMed

Bonavina L, Incarbone R, Segalin A, Chella B, Peracchia A. Duodeno-gastro-esophageal reflux after gastric surgery: surgical therapy and outcome in 42 consecutive patients. Hepato-Gastroenterology 1999; 46: 92–96.PubMed

10.

Adachi Y, Katsuta T, Aramaki M, Morimoto A, Shiraishi N, Kitano S. Proximal gastrectomy and gastric tube reconstruction for early cancer of the gastric cardia. Dig Surg 1999; 16: 468–470.PubMedCrossRef

11.

Adachi Y, Inoue T, Hagino Y, Shiraishi N, Shimoda K, Kitano S. Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction. Gastric Cancer 1999; 2: 40–45.PubMedCrossRef

12.

Li LH, Ma L, Xiao YL, Mao WZ, Li Y.Reconstructive approaches of alimentary canal for subtotal gastrectomy. Zhonghua Yi Xue Za Zhi 2011; 91: 961–964.(in Chinese with English abstract)PubMed

13.

Japanese Gastric Cancer Association: Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101–112.CrossRef

14.

Armstrong D, Bennett JR, Blum AL, Dent J, De Dombal FT, Galmiche JP, Lundell L, Margulies M, Richter JE, Spechler SJ, Tytgat GN, Wallin L. The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology 1996; 111: 85–92.PubMedCrossRef

15.

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: 172–180.PubMedCrossRef

16.

Hidenobu Watanabe, Jeremy R. Jass, L. H. Sobin. Histological typing of oesophageal and gastric tumours. New York: Springer-Verlag, 1990.CrossRef

17.

Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. Journal of gastrointestinal surgery 2013; 17: 962–972.PubMedCrossRef

18.

Adachi S, Kawamoto T, Otsuka M, Todoroki T, Fukao K. Enteral vitamin B12 supplements reverse postgastrectomy B12 deficiency. Ann surg 2000; 232: 199–201.PubMedCrossRef

19.

Nakane Y, Okumura S, Akehira K, Okamura S, Boku T, Okusa T, Tanaka K, Hioki K. Jejunal pouch reconstruction after total gastrectomy for cancer. A randomized controlled trial. Ann Surg 1995; 222: 27–35.PubMedCrossRef

20.

Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A. Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg 2008; 247: 759–765.PubMedCrossRef

21.

Gertler R, Rosenberg R, Feith M, Schuster T, Friess H. Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol 2009; 104: 2838–2851.PubMedCrossRef

22.

Kalmar K, Nemeth J, Kelemen D, Agoston E, Horvath OP. Postprandial gastrointestinal hormone production is different, depending on the type of reconstruction following total gastrectomy. Ann Surg 2006; 243: 465–471.PubMedCrossRef

23.

Kobayashi T, Sugimura H, Kimura T. Total gastrectomy is not always necessary for advanced gastric cancer of the cardia. Dig Surg 2002; 19: 15–21.PubMedCrossRef

24.

Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg 1989; 210: 596–602.PubMedCrossRef

25.

Kitamura K, Yamaguchi T, Nishida S, Yamamoto K, Ichikawa D, Okamoto K, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach. Surg Today 1997; 27: 993–998.PubMedCrossRef

26.

Kaibara N, Nishimura O, Nishidoi H, Kimura O, Koga S. Proximal gastrectomy as the surgical procedure of choice for upper gastric carcinoma. J Surg Oncol 1987; 36: 110–112.PubMedCrossRef

27.

Ooki A, Yamashita K, Kikuchi S, Sakuramoto S, Katada N, Hutawatari N, Watanabe M. Clinical significance of total gastrectomy for proximal gastric cancer. Anticancer Res 2008; 28: 2875–2883.PubMed

28.

Yoo CH, Sohn BH, Han WK, Pae WK. Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach. Cancer Res Treat 2004; 36: 50–55.PubMedCentralPubMedCrossRef

29.

An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 2008; 196: 587–591.PubMedCrossRef

30.

Hsu CP, Chen CY, Hsieh YH, Hsia JY, Shai SE, Kao CH. Esophageal reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia. Am J Gastroenterol 1997; 92: 1347–1350.PubMed

31.

Samosir DR, Lesmana L, Abdullah M. Delayed gastric emptying in an Indonesian population with reflux esophagitis. Acta Med Indones 2011; 43: 229–232.PubMed

32.

Nakane Y, Michiura T, Inoue K, Sato M, Nakai K, Ioka M, Yamamichi K. Role of pyloroplasty after proximal gastrectomy for cancer. Hepatogastroenterology 2004; 51: 1867–1871.PubMed

33.

Velanovich V. Esophagogastrectomy without pyloroplasty. Dis Esophagus 2003; 16: 243–245.PubMedCrossRef

34.

Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 2003; 90: 850–853.PubMedCrossRef

35.

Kameyama J, Ishida H, Yasaku Y, Suzuki A, Kuzu H, Tsukamoto M. Proximal gastrectomy reconstructed by interposition of a jejunal pouch. Surgical technique. Eur J Surg 1993; 159: 491–493.

36.

Kameyama J, Suzuki A, Takeshita A, Sakai Y, Kuzu H, Kudoh S. A new reconstructive procedure, interposition of a jejunal pouch after proximal gastrectomy. Nihon Geka Gakkai Zasshi 1997; 98: 555–559.PubMed

37.

Takagawa R, Kunisaki C, Kimura J, Makino H, Kosaka T, Ono HA, Akiyama H, Endo I. A pilot study comparing jejunal pouch and jejunal interposition reconstruction after proximal gastrectomy. Dig Surg 2010; 27: 502–508.PubMedCrossRef

38.

Namikawa T, Oki T, Kitagawa H, Okabayashi T, Kobayashi M, Hanazaki K. Impact of jejunal pouch interposition reconstruction after proximal gastrectomy for early gastric cancer on quality of life: short- and long-term consequences. Am J Surg 2012; 204: 203–209.PubMedCrossRef

39.

Seike K, Kinoshita T, Sugito M. Comparative studies between esophagogastrostomy and jejunal Interposition after proximal gastrectomy for cardiac cancer of the stomach [in Japanese]. Jpn J Gastroenterol Surg 1998; 31: 900–907.CrossRef

40.

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: 78–79.PubMedCrossRef

41.

Chen XF, Zhang B, Chen ZX, Hu JK, Dai B, Wang F, Yang HX, Chen JP. Gastric tube reconstruction reduces postoperative gastroesophageal reflux in adenocarcinoma of esophagogastric junction. Dig Dis Sci 2012; 57: 738–745.PubMedCrossRef

42.

Ardeman S, Chanarin I. Gastric intrinsic factor secretion after partial gastrectomy. Gut 1966; 7: 217–219.PubMedCrossRef

43.

Chanarin I. Gastric intrinsic factor. Gut 1968; 9: 373–375.PubMedCrossRef

Title: Esophagogastrostomy Plus Gastrojejunostomy: A Novel Reconstruction Procedure after Curative Resection for Proximal Gastric Cancer
Authors: Shicai Chen
Jianchang Li
Haiying Liu
Jun Zeng
Guohua Yang
Jin Wang
Weiqun Lu
Nanrong Yu
Zhiliang Huang
Houwei Xu
Xiang Zeng
Publication date: 01-03-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 3/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2391-2

At a glance: The STEP trials

Springer Medicine

Esophagogastrostomy Plus Gastrojejunostomy: A Novel Reconstruction Procedure after Curative Resection for Proximal Gastric Cancer

Abstract

Objective

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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