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Functional Advantages of Proximal Gastrectomy with Jejunal Interposition Over Total Gastrectomy with Roux-en-Y Esophagojejunostomy for Early Gastric Cancer

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Abstract

Background

The postoperative functional advantages of a proximal gastrectomy over a total gastrectomy remain debatable. The aim of this study was to evaluate the functional outcomes of a proximal gastrectomy with jejunal interposition (PG-JI), compared with those for a total gastrectomy with Roux-en-Y esophagojejunostomy (TG-RY), in patients with early gastric cancer.

Methods

Between 2007 and 2012, 65 patients underwent PG-JI and 117 underwent TG-RY for cT1 gastric cancer. Various parameters, including body weight, serum hemoglobin level, and interview-based symptoms, were prospectively evaluated in these patients. In patients who underwent PG-JI, the postoperative endoscopic findings were also assessed.

Results

All the surgeries were performed via a laparotomy alone. During a median postoperative follow-up of 42 months (range, 12–78 months), PG-JI offered significant reductions in body weight loss (12.5 ± 5.8 vs. 17.4 ± 6.4 %, P < 0.001), serum hemoglobin decline (7.0 ± 5.7 vs. 9.7 ± 5.4 %, P = 0.002), and dumping symptoms (11 % [7/65] vs. 30 % [35/117], P = 0.003), while being associated with similar incidences of anastomotic stricture (9 % [6/65] vs. 8 % [9/117], P = 0.781), small bowel obstruction (0 % [0/65] vs. 2 % [2/117], P = 0.538), stasis symptoms (51 % [33/65] vs. 44 % [51/117], P = 0.358), and reflux symptoms (34 % [22/65] vs. 23 % [27/117], P = 0.121), compared with TG-RY. Four cases of gastric remnant cancer and no cases of endoscopic reflux esophagitis were found after PG-JI.

Conclusions

PG-JI has clear functional advantages over TG-RY, although it requires active surveillance for remnant gastric cancer.

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Authors and Affiliations

  1. Gastric Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Masaki Ohashi, Shinji Morita, Takeo Fukagawa & Hitoshi Katai

  2. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Ichiro Oda

  3. Pathology Division, National Cancer Center Hospital, Tokyo, Japan

    Ryoji Kushima

Authors
  1. Masaki Ohashi
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  2. Shinji Morita
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  3. Takeo Fukagawa
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  4. Ichiro Oda
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  5. Ryoji Kushima
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  6. Hitoshi Katai
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Correspondence to Hitoshi Katai.

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Ohashi, M., Morita, S., Fukagawa, T. et al. Functional Advantages of Proximal Gastrectomy with Jejunal Interposition Over Total Gastrectomy with Roux-en-Y Esophagojejunostomy for Early Gastric Cancer. World J Surg 39, 2726–2733 (2015). https://doi.org/10.1007/s00268-015-3180-8

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  • DOI: https://doi.org/10.1007/s00268-015-3180-8

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