Functional Advantages of Proximal Gastrectomy with Jejunal Interposition Over Total Gastrectomy with Roux-en-Y Esophagojejunostomy for Early Gastric Cancer
- 529 Downloads
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.
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.
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.
PG-JI has clear functional advantages over TG-RY, although it requires active surveillance for remnant gastric cancer.
Compliance with ethical standards
Conflicts of interest
- 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
- 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
- 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
- 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