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01-06-2014 | Gastrointestinal Oncology

Feasibility and Nutritional Impact of Laparoscopy-assisted Subtotal Gastrectomy for Early Gastric Cancer in the Upper Stomach

Authors: Toshiyuki Kosuga, MD, PhD, Naoki Hiki, MD, PhD, Souya Nunobe, MD, PhD, Hisashi Noma, MD, PhD, Michitaka Honda, MD, Shinya Tanimura, MD, PhD, Takeshi Sano, MD, PhD, Toshiharu Yamaguchi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2014

Abstract

Background

Laparoscopy-assisted total gastrectomy (LATG) is commonly performed for early gastric cancer (EGC) in the upper stomach; however, the incidence of anastomotic complications remains high, and postoperative nutritional status is not satisfactory. This study aimed to evaluate the feasibility and nutritional impact of a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG).

Methods

This was a retrospective study of 167 patients with EGC in the upper stomach. Of these, 57 patients underwent LAsTG, while 110 patients underwent LATG. Postoperative change in body weight, and serum concentration of albumin (Alb) and total protein (TP) were compared between the LAsTG and LATG groups. Analysis of covariance (ANCOVA) was used to assess the influence of potential confounding factors.

Results

Frequency of anastomotic complications was significantly higher in the LATG group (16.3 %) than in the LAsTG group (5.3 %, P = 0.040). Postoperative recovery of body weight at 12 months after surgery was significantly better in the LAsTG group (89.8 ± 1.4 %) than in the LATG group (82.1 ± 1.0 %, P < 0.001). By ANCOVA, adjusted mean differences of Alb and TP at 12 months after surgery between the LAsTG and LATG groups were 0.226 g/dl (95 % CI 0.141–0.312; P < 0.001) and 0.380 g/dl (95 % CI 0.265–0.495; P < 0.001); thus, the surgical procedure was significantly associated with the postoperative Alb and TP levels.

Conclusions

LAsTG could be a better choice than LATG for EGC in the upper stomach as a result of improvements in the incidence of anastomotic complications and postoperative nutritional status.

Sano T, Hollowood A. Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg. 2006;95:249–55.PubMed

Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4:146–8.PubMed

Tanimura S, Higashino M, Fukunaga Y, Takemura M, Tanaka Y, Fujiwara Y, et al. Laparoscopic gastrectomy for gastric cancer: experience with more than 600 cases. Surg Endosc. 2008;22:1161–4.PubMedCrossRef

Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245:68–72.PubMedCentralPubMedCrossRef

Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.PubMedCentralPubMedCrossRef

Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, et al. Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized Trial (KLASS Trial). Ann Surg. 2010;251:417–20.PubMedCrossRef

Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.PubMedCrossRef

Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, et al. Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer. 2010;13:238–44.PubMedCrossRef

Lee SW, Nomura E, Bouras G, Tokuhara T, Tsunemi S, Tanigawa N. Long-term oncologic outcomes from laparoscopic gastrectomy for gastric cancer: a single-center experience of 601 consecutive resections. J Am Coll Surg. 2010;211:33–40.PubMedCrossRef

10.

Fukunaga T, Hiki N, Kubota T, Nunobe S, Tokunaga M, Nohara K, et al. Oncologic outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20:2676–82.PubMedCrossRef

11.

Okabayashi T, Gotoda T, Kondo H, Inui T, Ono H, Saito D, et al. Early carcinoma of the gastric cardia in Japan: is it different from that in the West? Cancer. 2000;89:2555–9.PubMedCrossRef

12.

Lee SE, Ryu KW, Nam BH, Lee JH, Kim YW, Yu JS, et al. Technical feasibility and safety of laparoscopy-assisted total gastrectomy in gastric cancer: a comparative study with laparoscopy-assisted distal gastrectomy. J Surg Oncol. 2009;100:392–5.PubMedCrossRef

13.

Nunobe S, Hiki N, Tanimura S, Kubota T, Kumagai K, Sano T, et al. Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg. 2011;15:1520–5.PubMedCrossRef

14.

Jeong O, Ryu SY, Zhao XF, Jung MR, Kim KY, Park YK. Short-term surgical outcomes and operative risks of laparoscopic total gastrectomy (LTG) for gastric carcinoma: experience at a large-volume center. Surg Endosc. 2012;26:3418–25.PubMedCrossRef

15.

Hiki N. Present features and future vision of laparoscopy-assisted total gastrectomy (LATG). Gastric Cancer. 2013;16:460–1.PubMedCrossRef

16.

Shim JH, Oh SI, Yoo HM, Jeon HM, Park CH, Song KY. Short-term outcomes of laparoscopic versus open total gastrectomy: a matched-cohort study. Am J Surg. 2013;206:346–51.PubMedCrossRef

17.

Troidl H, Kusche J, Vestweber KH, Eypasch E, Maul U. Pouch versus esophagojejunostomy after total gastrectomy: a randomized clinical trial. World J Surg. 1987;11:699–712.PubMedCrossRef

18.

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;247:759–65.PubMedCrossRef

19.

Mine S, Sano T, Tsutsumi K, Murakami Y, Ehara K, Saka M, et al. Large-scale investigation into dumping syndrome after gastrectomy for gastric cancer. J Am Coll Surg. 2010;211:628–36.PubMedCrossRef

20.

Liedman B, Andersson H, Berglund B, Bosaeus I, Hugosson I, Olbe L, et al. Food intake after gastrectomy for gastric carcinoma: the role of a gastric reservoir. Br J Surg. 1996;83:1138–43.PubMedCrossRef

21.

Jiang X, Hiki N, Nunobe S, Nohara K, Kumagai K, Sano T, et al. Laparoscopy-assisted subtotal gastrectomy with very small remnant stomach: a novel surgical procedure for selected early gastric cancer in the upper stomach. Gastric Cancer. 2011;14:194–9.PubMedCrossRef

22.

Hiki N, Nunobe S, Kubota T, Jiang X. Function-preserving gastrectomy for early gastric cancer. Ann Surg Oncol. 2013;20:2683–92.PubMedCrossRef

23.

Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.CrossRef

24.

Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

25.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCentralPubMedCrossRef

26.

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;196:587–91.PubMedCrossRef

27.

Kobayashi D, Kodera Y, Fujiwara M, Koike M, Nakayama G, Nakao A. Assessment of quality of life after gastrectomy using EORTC QLQ-C30 and STO22. World J Surg. 2011;35:357–64.PubMedCrossRef

28.

Nakamura M, Hosoya Y, Yano M, Doki Y, Miyashiro I, Kurashina K, et al. Extent of gastric resection impacts patient quality of life: the Dysfunction After Upper Gastrointestinal Surgery for Cancer (DAUGS32) scoring system. Ann Surg Oncol. 2011;18:314–20.PubMedCrossRef

29.

Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffith J, et al. Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg. 1998;22:1048–55.PubMedCrossRef

30.

Korenaga D, Orita H, Okuyama T, Moriguchi S, Maehara Y, Sugimachi K. Quality of life after gastrectomy in patients with carcinoma of the stomach. Br J Surg. 1992;79:248–50.PubMedCrossRef

31.

Anderson ID, MacIntyre IM. Symptomatic outcome following resection of gastric cancer. Surg Oncol. 1995;4:35–40.PubMedCrossRef

32.

Bozzetti F, Ravera E, Cozzaglio L, Dossena G, Agradi E, Bonfanti G, et al. Comparison of nutritional status after total or subtotal gastrectomy. Nutrition. 1990;6:371–5.PubMed

33.

Adachi S, Takiguchi S, Okada K, Yamamoto K, Yamasaki M, Miyata H, et al. Effects of ghrelin administration after total gastrectomy: a prospective, randomized, placebo-controlled phase II study. Gastroenterology. 2010;138:1312–20.PubMedCrossRef

34.

Takiguchi S, Adachi S, Yamamoto K, Morii E, Miyata H, Nakajima K, et al. Mapping analysis of ghrelin producing cells in the human stomach associated with chronic gastritis and early cancers. Dig Dis Sci. 2012;57:1238–46.PubMedCrossRef

35.

Takiguchi S, Hiura Y, Takahashi T, Kurokawa Y, Yamasaki M, Nakajima K, et al. Effect of rikkunshito, a Japanese herbal medicine, on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy. Gastric Cancer. 2013;16:167–74.PubMedCrossRef

Title: Feasibility and Nutritional Impact of Laparoscopy-assisted Subtotal Gastrectomy for Early Gastric Cancer in the Upper Stomach
Authors: Toshiyuki Kosuga, MD, PhD
Naoki Hiki, MD, PhD
Souya Nunobe, MD, PhD
Hisashi Noma, MD, PhD
Michitaka Honda, MD
Shinya Tanimura, MD, PhD
Takeshi Sano, MD, PhD
Toshiharu Yamaguchi, MD, PhD
Publication date: 01-06-2014
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 6/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-014-3520-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Feasibility and Nutritional Impact of Laparoscopy-assisted Subtotal Gastrectomy for Early Gastric Cancer in the Upper Stomach

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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