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Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer

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Abstract

Background

Few reports have compared laparoscopy-assisted proximal gastrectomy (LAPG) with laparoscopy-assisted total gastrectomy (LATG) in patients with cT1N0 gastric cancer. This study assessed the safety and feasibility of LAPG with esophagogastrostomy in these patients and compared postgastrectomy disturbances and nutritional status following LAPG and LATG.

Methods

This study compared 40 patients who underwent LAPG with esophagogastrostomy and 59 who underwent LATG with esophagojejunostomy, both with OrVil™. Surgical outcomes, postoperative complications, nutritional status at 1 and 2 years, and relapse-free survival were compared in these two groups.

Results

Operation time was significantly shorter in the LAPG group than in the LATG group (280 min vs. 365 min, P < 0.001). Although the rate of surgical complications was similar in the two groups, the rate of anastomotic stricture was significantly higher in the LAPG group than in the LATG group (28 vs. 8.4 %; P = 0.012). Rates of reflux esophagitis graded A or higher in the Los Angeles classification were 10 and 5.1 %, respectively. Hemoglobin levels 2 years after surgery, relative to baseline levels, were significantly higher in the LAPG group than in the LATG group (98.6 vs. 92.9 %, P = 0.020). Body weight, albumin and total protein concentrations, and total lymphocyte count 1 and 2 years after surgery were slightly, but not significantly, higher in the LAPG group. Relapse-free survival rates were similar, as were 5-year overall survival rates (86 vs. 79 %, P = 0.42).

Conclusions

LAPG with esophagogastrostomy using OrVil™ was safe and feasible for patients with cT1N0 gastric cancer. LAPG may have nutritional advantages over LATG, but the rate of anastomotic stricture was significantly higher for LAPG than for LATG.

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Authors and Affiliations

  1. Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Kei Hosoda, Keishi Yamashita, Natsuya Katada, Hiromitsu Moriya, Hiroaki Mieno, Shiro Kikuchi & Masahiko Watanabe

  2. Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan

    Tomotaka Shibata

  3. Department of Gastrointestinal Surgery, Saitama Medical University International Medical Center, Saitama, Japan

    Shinichi Sakuramoto

Authors
  1. Kei Hosoda
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  2. Keishi Yamashita
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  3. Natsuya Katada
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  4. Hiromitsu Moriya
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  9. Masahiko Watanabe
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Correspondence to Kei Hosoda.

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Disclosures

Drs. Kei Hosoda, Keishi Yamashita, Natsuya Katada, Hiromitsu Moriya, Hiroaki Mieno, Tomotaka Shibata, Shinichi Sakuramoto, Shiro Kikuchi, and Masahiko Watanabe have no conflicts of interest or financial ties to disclose.

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Hosoda, K., Yamashita, K., Katada, N. et al. Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer. Surg Endosc 30, 3426–3436 (2016). https://doi.org/10.1007/s00464-015-4625-8

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  • DOI: https://doi.org/10.1007/s00464-015-4625-8

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