Top

Published in:

01-09-2017

Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life

Authors: Tatsuto Nishigori, Hiroshi Okabe, Shigeru Tsunoda, Hisashi Shinohara, Kazutaka Obama, Hisahiro Hosogi, Shigeo Hisamori, Kikuko Miyazaki, Takeo Nakayama, Yoshiharu Sakai

Published in: Surgical Endoscopy | Issue 9/2017

Abstract

Background

Proximal gastrectomy is not widely performed because the procedure is complicated, particularly under laparoscopy. We developed a simple laparoscopic technique of hand-sewn esophagogastrostomy with an anti-reflux mechanism. This study aimed to evaluate and compare the postoperative body weight loss (BWL) and quality of life (QOL) following laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) in patients with upper gastric cancer.

Methods

We retrospectively analyzed patients with stage I upper gastric cancer undergoing LPG or LTG at Kyoto University Hospital between March 2006 and June 2014. The main outcome measures were the % BWL 1 year after gastrectomy, postoperative anastomotic stricture, and reflux esophagitis. Additionally, patient-reported outcomes were evaluated using the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45 in patients presenting at the outpatient clinic and exhibiting no recurrence.

Results

A total of 62 patients were included in this study (LTG, n = 42 vs. LPG, n = 20). The % BWL at 12 months in the LPG group was less than that in the LTG group (−16.3 vs. −10.7%). Multivariate analysis revealed that LPG was associated with less BWL (P = 0.003). Anastomotic stricture occurred more frequently in the LPG group than in the LTG group (0 vs. 25%). One patient in each group exhibited grade B severity of reflux esophagitis (based on the Los Angeles classification). In the questionnaire survey, LPG was better than LTG in terms of diarrhea and dissatisfaction with symptoms. In terms of reflux symptoms, patients in the LPG group experienced less acid and bile regurgitation symptoms compared with those in the LTG group.

Conclusions

LPG with hand-sewn esophagogastrostomy results in less postoperative BWL and better QOL than LTG despite higher rates of anastomotic stricture.

Available only for authorised users

Carr JS, Zafar SF, Saba N, Khuri FR, El-Rayes BF (2013) Risk factors for rising incidence of esophageal and gastric cardia adenocarcinoma. J Gastrointest Cancer 44(2):143–151CrossRefPubMed

Blaser MJ, Saito D (2002) Trends in reported adenocarcinomas of the oesophagus and gastric cardia in Japan. Eur J Gastroenterol Hepatol 14(2):107–113CrossRefPubMed

Deans C, Yeo MSW, Soe MY, Shabbir A, Ti TK, So JBY (2011) Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg 35(3):617–624CrossRefPubMed

Fein M, Fuchs KH, Thalheimer A, Freys SM, Heimbucher J, Thiede A (2008) Long-term benefits of Roux-en-Y pouch reconstruction after total gastrectomy: a randomized trial. Ann Surg 247(5):759–765CrossRefPubMed

Kiyama T, Mizutani T, Okuda T, Fujita I, Tokunaga A, Tajiri T, Barbul A (2005) Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 9(3):313–319CrossRefPubMed

O’Gorman P, McMillan DC, McArdle CS (1998) Impact of weight loss, appetite, and the inflammatory response on quality of life in gastrointestinal cancer patients. Nutr Cancer 32(2):76–80CrossRefPubMed

Huh YJ, Lee HJ, Oh SY, Lee KG, Yang JY, Ahn HS, Suh YS, Kong SH, Lee KU, Yang HK (2015) 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 15(3):191–200CrossRefPubMedPubMedCentral

Yoo CH, Sohn BH, Han WK, Pae WK (2004) Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach. Cancer Res Treat 36(1):50–55CrossRefPubMedPubMedCentral

An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S (2008) The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 196(4):587–591CrossRefPubMed

10.

Karanicolas PJ, Graham D, Gonen M, Strong VE, Brennan MF, Coit DG (2013) Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg 257(6):1039–1046CrossRefPubMedPubMedCentral

11.

Ahn SH, Lee JH, do Park J, Kim HH (2013) Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer 16(3):282–289CrossRefPubMed

12.

Uyama I, Okabe H, Kojima K, Satoh S, Shiraishi N, Suda K, Takiguchi S, Nagai E, Fukunaga T (2015) Gastroenterological surgery: stomach. Asian J Endosc Surg 8(3):227–238CrossRefPubMed

13.

Okabe H, Obama K, Tanaka E, Tsunoda S, Akagami M, Sakai Y (2013) Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric Cancer 16(2):268–274CrossRefPubMed

14.

Japanese Gastric Cancer Society (2004) Guidelines for diagnosis and treatment of carcinoma of the stomach April 2004 edition. http://www.jgca.jp/pdf/Guidelines2004_eng.pdf. Accessed 1 Dec 2016

15.

Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14(2):113–123CrossRef

16.

Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14(2):101–112

17.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentral

18.

Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45(2):172–180CrossRefPubMedPubMedCentral

19.

Nakada K, Ikeda M, Takahashi M, Kinami S, Yoshida M, Uenosono Y, Kawashima Y, Oshio A, Suzukamo Y, Terashima M, Kodera Y (2015) Characteristics and clinical relevance of postgastrectomy syndrome assessment scale (PGSAS)-45: newly developed integrated questionnaires for assessment of living status and quality of life in postgastrectomy patients. Gastric Cancer 18(1):147–158CrossRefPubMed

20.

Fukuhara S, Suzukamo Y (eds) (2004) Manual of the SF-8 Japanese version. Institute for Health Outcomes and Process Evaluation research, Kyoto

21.

Okabe H, Obama K, Kan T, Tanaka E, Itami A, Sakai Y (2010) Medial approach for laparoscopic total gastrectomy with splenic lymph node dissection. J Am Coll Surg 211(1):e1–e6CrossRefPubMed

22.

Satoh S, Okabe H, Kondo K, Tanaka E, Itami A, Kawamura J, Nomura A, Nagayama S, Watanabe G, Sakai Y (2009) Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer. Surg Endosc 23(2):436–437CrossRefPubMed

23.

Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259(1):109–116CrossRefPubMed

24.

Okabe H, Obama K, Tanaka E, Nomura A, J-i Kawamura, Nagayama S, Itami A, Watanabe G, Kanaya S, Sakai Y (2009) Intracorporeal esophagojejunal anastomosis after laparoscopic total gastrectomy for patients with gastric cancer. Surg Endosc 23(9):2167–2171CrossRefPubMed

25.

Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M (2003) Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 90(7):850–853CrossRefPubMed

26.

Sasazuki S, Inoue M, Tsuji I, Sugawara Y, Tamakoshi A, Matsuo K, Wakai K, Nagata C, Tanaka K, Mizoue T, Tsugane S, Research Group for the Development and Evaluation of Cancer Prevention (2011) Body mass index and mortality from all causes and major causes in Japanese: results of a pooled analysis of 7 large-scale cohort studies. Int J Epidemiol 21(6):417–430CrossRef

27.

Zhu Y, Wang Q, Pang G, Lin L, Origasa H, Wang Y, Di J, Shi M, Fan C, Shi H (2015) Association between body mass index and health-related quality of Life: the “obesity paradox” in 21,218 adults of the Chinese general population. PLoS ONE 10(6):e0130613CrossRefPubMedPubMedCentral

28.

Takiguchi N, Takahashi M, Ikeda M, Inagawa S, Ueda S, Nobuoka T, Ota M, Iwasaki Y, Uchida N, Kodera Y, Nakada K (2015) Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by Postgastrectomy Syndrome Assessment Scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer 18(2):407–416CrossRefPubMed

29.

Fujita J, Takahashi M, Urushihara T, Tanabe K, Kodera Y, Yumiba T, Matsumoto H, Takagane A, Kunisaki C, Nakada K (2016) Assessment of postoperative quality of life following pylorus-preserving gastrectomy and Billroth-I distal gastrectomy in gastric cancer patients: results of the nationwide postgastrectomy syndrome assessment study. Gastric Cancer 19(1):302–311CrossRefPubMed

30.

Kim SM, Cho J, Kang D, Oh SJ, Kim AR, Sohn TS, Noh JH, Kim S (2016) A randomized controlled trial of vagus nerve-preserving distal gastrectomy versus conventional distal gastrectomy for postoperative quality of life in early stage gastric cancer patients. Ann Surg 263(6):1079–1084CrossRefPubMed

31.

Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S, Shirakawa Y, Fujiwara T (2016) Double-flap technique as an antireflux procedure in esophagogastrostomy after proximal gastrectomy. J Am Coll Surg 223(2):e7–e13CrossRefPubMed

Title: Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life
Authors: Tatsuto Nishigori
Hiroshi Okabe
Shigeru Tsunoda
Hisashi Shinohara
Kazutaka Obama
Hisahiro Hosogi
Shigeo Hisamori
Kikuko Miyazaki
Takeo Nakayama
Yoshiharu Sakai
Publication date: 01-09-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5403-y

At a glance: The STEP trials

Springer Medicine

Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2017

Uptake of enhanced recovery practices by SAGES members: a survey

Optimal timing for a second ERCP after failure of initial biliary cannulation following precut sphincterotomy: an analysis of experience at two tertiary centers

Laparoscopic-assisted versus open total gastrectomy for Siewert type II and III esophagogastric junction carcinoma: a propensity score-matched case-control study

Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract

Alvimopan in the setting of colorectal resection with an ostomy: To use or not to use?

Clinical practice guideline for enhanced recovery after colon and rectal surgery from the American Society of Colon and Rectal Surgeons (ASCRS) and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)