World Journal of Surgery

, Volume 39, Issue 11, pp 2726–2733 | Cite as

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

  • Masaki Ohashi
  • Shinji Morita
  • Takeo Fukagawa
  • Ichiro Oda
  • Ryoji Kushima
  • Hitoshi Katai
Original Scientific Report

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.

Notes

Grant support

None.

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Parkin DM (2004) International variation. Oncogene 23:6329–6340CrossRefPubMedGoogle Scholar
  2. 2.
    Sehdev A, Catenacci DV (2013) Gastroesophageal cancer: focus on epidemiology, classification, and staging. Discov Med 16:103–111PubMedGoogle Scholar
  3. 3.
    Yamashita H, Katai H, Morita S et al (2011) Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg 254:274–280CrossRefPubMedGoogle Scholar
  4. 4.
    Ahn HS, Lee HJ, Yoo MW et al (2011) Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 98:255–260CrossRefPubMedGoogle Scholar
  5. 5.
    Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123CrossRefGoogle Scholar
  6. 6.
    Shiraishi N, Adachi Y, Kitano S et al (2002) Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg 26:1150–1154. doi:10.1007/s00268-002-6369-6 CrossRefPubMedGoogle Scholar
  7. 7.
    An JY, Youn HG, Choi MG et al (2008) The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 196:587–591CrossRefPubMedGoogle Scholar
  8. 8.
    Karanicolas PJ, Graham D, Gönen M et al (2013) Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg 257:1039–1046PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Kumagai K, Shimizu K, Yokoyama N, Japanese Society for the Study of Postoperative Morbidity after Gastrectomy et al (2012) Questionnaire survey regarding the current status and controversial issues concerning reconstruction after gastrectomy in Japan. Surg Today 42:411–418CrossRefPubMedGoogle Scholar
  10. 10.
    Tokunaga M, Ohyama S, Hiki N et al (2008) Endoscopic evaluation of reflux esophagitis after proximal gastrectomy: comparison between esophagogastric anastomosis and jejunal interposition. World J Surg 32:1473–1477. doi:10.1007/s00268-007-9459-7 CrossRefPubMedGoogle Scholar
  11. 11.
    Katai H, Sano T, Fukagawa T et al (2003) Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 90:850–853CrossRefPubMedGoogle Scholar
  12. 12.
    Katai H, Morita S, Saka M et al (2010) Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg 97:558–562CrossRefPubMedGoogle Scholar
  13. 13.
    Sobin LH, Gospodarowicz MK, Wittekind C, Stomach, ICD-OC16 (2009) TNM classification of malignant tumors, 7th edn. Wiley-Blackwell, New York, pp 73–77Google Scholar
  14. 14.
    Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112CrossRefGoogle Scholar
  15. 15.
    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 240:205–213PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Tomita R, Fujisaki S, Tanjoh K (2003) Pathophysiological studies on the relationship between postgastrectomy syndrome and gastric emptying function at 5 years after pylorus-preserving distal gastrectomy for early gastric cancer. World J Surg 27:725–733. doi:10.1007/s00268-003-6906-y CrossRefPubMedGoogle Scholar
  17. 17.
    Kubo M, Sasako M, Gotoda T et al (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89CrossRefPubMedGoogle Scholar
  18. 18.
    Nozaki I, Hato S, Kobatake T et al (2013) Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg 37:558–564. doi:10.1007/s00268-012-1894-4 CrossRefPubMedGoogle Scholar
  19. 19.
    Ichikawa D, Komatsu S, Kubota T et al (2014) Long-term outcomes of patients who underwent limited proximal gastrectomy. Gastric Cancer 17:141–145CrossRefPubMedGoogle Scholar
  20. 20.
    Nunobe S, Sasako M, Saka M et al (2007) Symptom evaluation of long-term postoperative outcomes after pylorus-preserving gastrectomy for early gastric cancer. Gastric Cancer 10:167–172CrossRefPubMedGoogle Scholar
  21. 21.
    Ohashi M, Katai H, Fukagawa T et al (2007) Cancer of the gastric stump following distal gastrectomy for cancer. Br J Surg 94:92–95CrossRefPubMedGoogle Scholar
  22. 22.
    Sakuramoto S, Yamashita K, Kikuchi S et al (2009) Clinical experience of laparoscopy-assisted proximal gastrectomy with Toupet-like partial fundoplication in early gastric cancer for preventing reflux esophagitis. J Am Coll Surg 209:344–351CrossRefPubMedGoogle Scholar
  23. 23.
    Kinoshita T, Gotohda N, Kato Y et al (2013) Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery. Surg Endosc 27:146–153CrossRefPubMedGoogle Scholar
  24. 24.
    Shinohara T, Kanaya S, Taniguchi K et al (2009) Laparoscopic total gastrectomy with D2 lymph node dissection for gastric cancer. Arch Surg 144:1138–1142CrossRefPubMedGoogle Scholar
  25. 25.
    Wada N, Kurokawa Y, Takiguchi S et al (2014) Feasibility of laparoscopy-assisted total gastrectomy in patients with clinical stage I gastric cancer. Gastric Cancer 17:137–140CrossRefPubMedGoogle Scholar
  26. 26.
    Svedlund J, Sjodin I, Dotevall G (1988) GSRS—a clinical rating scale for gastrointestinal symptoms in patients with irritable bowel syndrome and peptic ulcer disease. Dig Dis Sci 33:129–134CrossRefPubMedGoogle Scholar
  27. 27.
    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376CrossRefPubMedGoogle Scholar
  28. 28.
    Vickery CW, Blazeby JM, Conroy T et al (2001) Development of an EORTC disease-specific quality of life module for use in patients with gastric cancer. Eur J Cancer 37:966–971CrossRefPubMedGoogle Scholar
  29. 29.
    Nakamura M, Kido Y, Yano M et al (2005) Reliability and validity of a new scale to assess postoperative dysfunction after resection of upper gastrointestinal carcinoma. Surg Today 35:535–542CrossRefPubMedGoogle Scholar
  30. 30.
    Nakamura M, Hosoya Y, Umeshita K et al (2011) Postoperative quality of life: development and validation of the “Dysfunction After Upper Gastrointestinal Surgery” scoring system. J Am Coll Surg 213:508–514CrossRefPubMedGoogle Scholar
  31. 31.
    Nakada K, Ikeda M, Takahashi M et al (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 18:147–158CrossRefPubMedGoogle Scholar
  32. 32.
    Takiguchi N, Takahashi M, Ikeda M et al (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 18:407–416CrossRefPubMedGoogle Scholar
  33. 33.
    Inada T, Yoshida M, Ikeda M et al (2014) Evaluation of QOL after proximal gastrectomy using a newly developed assessment scale (PGSAS-45). World J Surg 38:3152–3162. doi:10.1007/s00268-014-2712-y CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2015

Authors and Affiliations

  • Masaki Ohashi
    • 1
  • Shinji Morita
    • 1
  • Takeo Fukagawa
    • 1
  • Ichiro Oda
    • 2
  • Ryoji Kushima
    • 3
  • Hitoshi Katai
    • 1
  1. 1.Gastric Surgery DivisionNational Cancer Center HospitalTokyoJapan
  2. 2.Endoscopy DivisionNational Cancer Center HospitalTokyoJapan
  3. 3.Pathology DivisionNational Cancer Center HospitalTokyoJapan

Personalised recommendations