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Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014

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Abstract

Proximal gastrectomy (PG) is occasionally performed to preserve the physiological function of the remnant stomach with the aim of maintaining a gastric reservoir for patients with early gastric cancer in the upper third of the stomach. Many reconstructive procedures after PG have been reported, including esophagogastrostomy (EG), jejunal interposition, jejunal pouch interposition, and double tract. However, no general agreement exists regarding the optimal reconstructive procedure. This article reviews the current reconstructive procedures available for PG. We examined the surgical outcomes, postoperative complications, endoscopic findings, and quality of life (QOL) according to the reconstructive procedures. We found no significant difference in anastomotic leakage and anastomotic stricture among the procedures. The frequency of reflux esophagitis was higher with simple EG compared with the other reconstructive procedures. Some additional procedures, such as fundoplication, the use of a narrow gastric conduit, and placement of a gastric tube in the lower mediastinum on EG, could decrease the frequency of reflux esophagitis and reflux symptoms. These additional procedures may improve the QOL; however, the previous studies were small and could not adequately compare the reconstructive procedures. Prospective randomized controlled trials that involve a longer trial period and more institutions are needed to clarify the optimal reconstructive procedures after PG.

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Abbreviations

PG:

Proximal gastrectomy

EG:

Esophagogastrostomy

JI:

Jejunal interposition

JPI:

Jejunal pouch interposition

DT:

Double tract

OPG:

Open proximal gastrectomy

LAPG:

Laparoscopy-assisted proximal gastrectomy

LPG:

Laparoscopic proximal gastrectomy

QOL:

Quality of life

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Conflict of interest

The authors have no conflicts of interest to declare in association with this study.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Masaki Nakamura & Hiroki Yamaue

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  1. Masaki Nakamura
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  2. Hiroki Yamaue
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Correspondence to Hiroki Yamaue.

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Nakamura, M., Yamaue, H. Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014. Surg Today 46, 517–527 (2016). https://doi.org/10.1007/s00595-015-1185-4

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  • DOI: https://doi.org/10.1007/s00595-015-1185-4

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