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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Gastrointestinal Oncology

Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach

Authors: Masaru Hayami, MD, PhD, Naoki Hiki, MD, PhD, Souya Nunobe, MD, PhD, Shinji Mine, MD, Manabu Ohashi, MD, PhD, Koshi Kumagai, MD, PhD, Satoshi Ida, MD, PhD, Masayuki Watanabe, MD, PhD, Takeshi Sano, MD, PhD, Toshiharu Yamaguchi, MD, PhD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Background

A novel double-flap esophagogastrostomy technique developed to prevent reflux after proximal gastrectomy was applied to laparoscopic proximal gastrectomy (LPG), and the clinical outcomes of this technique (LPG-DFT) were evaluated and compared to those of laparoscopic total gastrectomy (LTG).

Methods

This retrospective study of 90 patients with early gastric cancer (EGC) in the upper third of the stomach compared surgical outcomes, postoperative endoscopic findings, and nutritional status between two procedure groups, LPG-DFT (n = 43) and LTG (n = 47). The association between morbidity and surgical procedure was analyzed by controlling for body mass index (BMI).

Results

Mean operation time was significantly higher for LPG-DFT than LTG (386.5 vs. 316.3 min, P < 0.001). The morbidity and the frequency of anastomotic complications were lower, although not significantly, for LPG-DFT than LTG (7.0 vs. 21.3%, P = 0.073; and 4.7 vs. 17.2%, P = 0.093). Median postoperative hospital stay was significantly shorter for LPG-DFT than LTG (10 vs. 13 days, P = 0.002). The LPG-DFT procedure was identified as the most significant independent predictor of low morbidity after adjustment for BMI (P = 0.028, OR = 0.232, 95% CI 0.047–0.862). LTG induced more severe reflux esophagitis than LPG-DFT (14.9% vs. 2.3%, P = 0.06). The mean baseline weight, total protein, and hemoglobin were significantly higher with LPG-DFT than with LTG (P < 0.05).

Conclusions

LPG-DFT is a better surgical procedure for treating upper-third EGC than LTG in terms of morbidity, postoperative hospital stay, and postoperative nutritional status.
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Metadata
Title
Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach
Authors
Masaru Hayami, MD, PhD
Naoki Hiki, MD, PhD
Souya Nunobe, MD, PhD
Shinji Mine, MD
Manabu Ohashi, MD, PhD
Koshi Kumagai, MD, PhD
Satoshi Ida, MD, PhD
Masayuki Watanabe, MD, PhD
Takeshi Sano, MD, PhD
Toshiharu Yamaguchi, MD, PhD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-017-5782-x

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