Skip to main content

Laparoscopic Proximal Gastrectomy Maintains Body Weight and Skeletal Muscle Better Than Total Gastrectomy

World Journal of Surgery volume 42, pages 3270–3276 (2018)Cite this article

Abstract

Background

Laparoscopic proximal gastrectomy (LPG) is performed as a function-preserving surgery for patients with early proximal gastric malignant tumors; however, whether LPG has advantages postoperatively compared with laparoscopic total gastrectomy (LTG) is debatable, especially with regard to nutritional outcomes.

Methods

We evaluated 20 patients who underwent LTG and 10 patients who underwent LPG with double tract reconstruction (LPG-DT) who were diagnosed preoperatively with T1a or T1b N0 Stage IA gastric cancer in our department in the same time period. The statistical relevance of complications, surgical maneuvers, clinical factors and changes in weight, skeletal muscle index (SMI) and serum albumin levels after surgery was compared between the LPG-DT group and the LTG group.

Results

No differences between groups were observed in patient demographics, operation time, blood loss, complications, number of dissected lymph nodes and pathological stage. The body weight reduction rate was significantly lower in the LPG-DT group compared with the LTG group at 6 months (5.7 vs. 14.9%, respectively; p = 0.0045) and 1 year after surgery (9.6 vs. 17.9%, respectively; p = 0.0042). The SMI reduction rate of the LPG-DT group in the first postoperative year was significantly lower than that of the LTG group (9.3 vs. 18.3%, respectively; p = 0.0057).

Conclusions

Patients with early gastric cancer who underwent LPG-DT had acceptable morbidity and mortality, similar to those who underwent LTG. Body weight and SMI reduction rates were lower in the LPG-DT group than in the LTG group. Thus, LPG-DT is an appropriate procedure for patients with clinical Stage IA proximal gastric cancer.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1

References

  1. Torre LA, Bray F, Siegel RL et al (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108

    Article  PubMed  Google Scholar 

  2. Sano T, Hollowood A (2006) Early gastric cancer: diagnosis and less invasive treatments. Scand J Surg 95:249–255

    Article  PubMed  CAS  Google Scholar 

  3. 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 98:255–260

    Article  PubMed  CAS  Google Scholar 

  4. Borch K, Jonsson B, Tarpila E et al (2000) Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma. Br J Surg 87:618–626

    Article  PubMed  CAS  Google Scholar 

  5. Saito T, Kurokawa Y, Takiguchi S et al (2014) Current status of function-preserving surgery for gastric cancer. World J Gastroenterol 20:17297–17304

    Article  PubMed  PubMed Central  Google Scholar 

  6. Japanese Gastric Cancer Association (2014) Japanese gastric cancer treatment guidelines 2014 (ver.4). Kanehara publication, Tokyo

    Google Scholar 

  7. 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. https://doi.org/10.1007/s00268-012-1894-4

    Article  PubMed  Google Scholar 

  8. Ikeguchi M, Kader A, Takaya S et al (2012) Prognosis of patients with gastric cancer who underwent proximal gastrectomy. Int Surg 97:275–279

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ahn SH, Lee JH, Park DJ et al (2013) Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer 16:282–289

    Article  PubMed  Google Scholar 

  10. Zelnick R, Auguste LJ, Wise L (1989) Nutritional effects of postgastrectomy reconstruction: a clinical evaluation. J Surg Oncol 40:219–221

    Article  PubMed  CAS  Google Scholar 

  11. Kiyama T, Mizutani T, Okuda T et al (2005) Postoperative changes in body composition after gastrectomy. J Gastrointest Surg 9:313–319

    Article  PubMed  Google Scholar 

  12. Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127:990S–991S

    Article  PubMed  CAS  Google Scholar 

  13. Levolger S, van Vugt JL, de Bruin RW et al (2015) Systematic review of sarcopenia in patients operated on for gastrointestinal and hepatopancreatobiliary malignancies. Br J Surg 102:1448–1458

    Article  PubMed  CAS  Google Scholar 

  14. Lieffers JR, Bathe OF, Fassbender K et al (2012) Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer 107:931–936

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Yoshizumi T, Shirabe K, Nakagawara H et al (2014) Skeletal muscle area correlates with body surface area in healthy adults. Hepatol Res 44:313–318

    Article  PubMed  Google Scholar 

  16. Wagner D, DeMarco MM, Amini N et al (2016) Role of frailty and sarcopenia in predicting outcomes among patients undergoing gastrointestinal surgery. World J Gastrointest Surg 8:27–40

    Article  PubMed  PubMed Central  Google Scholar 

  17. Japanese Gastric Cancer A (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  18. Saeki H, Oki E, Kawano H et al (2013) Newly developed liver-retraction method for laparoscopic gastric surgery using a silicone disc: the phi-shaped technique. J Am Coll Surg 216:e43–46

    Article  PubMed  Google Scholar 

  19. Kim HI, Hyung WJ, Lee CR et al (2011) Intraoperative portable abdominal radiograph for tumor localization: a simple and accurate method for laparoscopic gastrectomy. Surg Endosc 25:958–963

    Article  PubMed  Google Scholar 

  20. Imamura Y, Oki E, Ohgaki K et al (2016) Real-time accurate identification of tumor site using a mobile X-ray image-intensifier system during laparoscopic gastrectomy. J Am Coll Surg 222:e1–7

    Article  PubMed  Google Scholar 

  21. Hiyoshi Y, Oki E, Ando K et al (2014) Outcome of esophagojejunostomy during totally laparoscopic total gastrectomy: a single-center retrospective study. Anticancer Res 34:7227–7232

    PubMed  Google Scholar 

  22. Sugiyama M, Oki E, Ogaki K et al (2017) Clinical outcomes of esophagojejunostomy in totally laparoscopic total gastrectomy: a multicenter study. Surg Laparosc Endosc Percutan Tech 27:e87–e91

    Article  PubMed  Google Scholar 

  23. Harrison LE, Karpeh MS, Brennan MF (1998) Total gastrectomy is not necessary for proximal gastric cancer. Surgery 123:127–130

    Article  PubMed  CAS  Google Scholar 

  24. 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. https://doi.org/10.1007/s00268-002-6369-6

    Article  PubMed  Google Scholar 

  25. 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 196:587–591

    Article  PubMed  Google Scholar 

  26. 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 18:407–416

    Article  PubMed  Google Scholar 

  27. Kosuga T, Ichikawa D, Komatsu S et al (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 22(Suppl 3):S929–935

    Article  PubMed  Google Scholar 

  28. Jung DH, Lee Y, Kim DW et al (2017) Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer. Surg Endosc 31:3961–3969

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by JSPS KAKENHI Grant Number JP17K16564.

Author information

Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Masahiko Sugiyama, Eiji Oki, Koji Ando, Yuichiro Nakashima, Hiroshi Saeki & Yoshihiko Maehara

  2. Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Masahiko Sugiyama

Authors
  1. Masahiko Sugiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eiji Oki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koji Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuichiro Nakashima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroshi Saeki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshihiko Maehara
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MS designed the study and wrote the manuscript. EO and HS provided advice and edited the manuscript. KA and YN gathered data from each institute. YM discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Masahiko Sugiyama.

Ethics declarations

Conflict of interest

The authors declare that they have no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sugiyama, M., Oki, E., Ando, K. et al. Laparoscopic Proximal Gastrectomy Maintains Body Weight and Skeletal Muscle Better Than Total Gastrectomy. World J Surg 42, 3270–3276 (2018). https://doi.org/10.1007/s00268-018-4625-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-018-4625-7