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Feasibility and quality of life assessment of laparoscopic proximal gastrectomy using double-tract reconstruction

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Abstract

Purpose

As the frequency of cancer in the proximal stomach or around the esophagogastric junction (EGJ) increases worldwide, the use of laparoscopic proximal gastrectomy (LPG) has expanded. This study evaluated the safety of LPG with double-tract reconstruction (LPG-DT) and the resulting quality of life (QOL) of patients.

Methods

In this retrospective cohort study, we reviewed the data of patients who underwent LPG-DT via linear-stapled esophagojejunostomy for gastric or EGJ cancer between 2013 and 2019, and outcomes were compared with those of laparoscopic total gastrectomy with Roux-en-Y reconstruction (LTG-RY) peMME000372rformed over the same period. Surgical outcomes, changes of nutritional parameters, and chronological QOL as evaluated using the Postgastrectomy Syndrome Assessment Scale (PGSAS-37) questionnaire were compared in the propensity-matched cohorts.

Results

In total, 289 patients (99 LPG-DT and 190 LTG-RY) were eligible and the outcomes were evaluated in the propensity-matched cohorts (n = 75 each). Operative time and the incidence of complications (≥ grade III) were comparable. Reflux esophagitis was more frequent in the LPG-DT group (8.0% vs. 0%), whereas the incidence of anastomotic stricture did not differ. The percentage rates of body weight loss and hemoglobin reduction were lower in the LPG-DT group at any time point within postoperative 2 years but show no statistical differences. In PGSAS-37 (n = 26, n = 23), the diarrhea and quality of ingestion scores were slightly better in the LPG-DT group.

Conclusions

The present study suggested that our LPG-DT is feasible and safe in appropriately selected patients, and it may provide slightly better outcomes in nutrition and QOL compared with LTG-RY.

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Data availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Joe Barber Jr., PhD, from Edanz Group (https://en-author-services.edanzgroup.com/), for editing a draft of this manuscript.

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Authors and Affiliations

  1. Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan

    Reo Sato, Takahiro Kinoshita, Eigo Akimoto, Mitsumasa Yoshida, Yukiko Nishiguchi & Junichiro Harada

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  1. Reo Sato
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  2. Takahiro Kinoshita
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  4. Mitsumasa Yoshida
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Contributions

Study conception and design: R. Sato and T. Kinoshita. Acquisition of data: R. Sato, E. Akimoto, M. Yoshida, Y. Nishiguchi, and J. Harada. Analysis and interpretation of data: R. Sato and T. Kinoshita. Drafting of the manuscript: R. Sato. Critical revision of the manuscript: T. Kinoshita.

Corresponding author

Correspondence to Takahiro Kinoshita.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Declaration of Helsinki of 1964 and later versions. The study was approved by the domestic institutional review board at our center (IRB file no. 2017-416; approval date, March 2, 2018).

Consent to participate

The opportunity for patients to opt out was provided; however, the requirement for obtaining informed consent was waived because of a retrospective study.

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The opportunity for patients to opt out was provided; however, the requirement for obtaining informed consent was waived because of a retrospective study.

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Sato, R., Kinoshita, T., Akimoto, E. et al. Feasibility and quality of life assessment of laparoscopic proximal gastrectomy using double-tract reconstruction. Langenbecks Arch Surg 406, 479–489 (2021). https://doi.org/10.1007/s00423-020-02076-7

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