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Size-dependent differences in the proximal remnant stomach: how much does a small remnant stomach after subtotal gastrectomy work?

Surgical Endoscopy volume 34, pages 5540–5549 (2020)Cite this article

Abstract

Background

The application of laparoscopic subtotal gastrectomy (LsTG) in the management of early gastric cancer located in the upper third of the stomach creates an extremely small remnant stomach (SRS). However, it is unclear whether retaining such an SRS improves patients’ postoperative outcomes in a similar manner to a conventional remnant stomach (CRS).

Methods

Four hundred and nine of 878 patients undergoing laparoscopic distal gastrectomy (LDG) between 2006 and 2012 underwent Roux-en-Y reconstruction. Among them, we selected 73 patients who underwent LsTG with an SRS (SRS group), and 83 patients with the tumor in the lower third of the stomach who underwent LDG with a CRS (CRS group). The surgical outcomes at 1 and 6 months, 1, 2, and 3 years after gastrectomy were retrospectively analyzed and compared between the two groups.

Results

One year after gastrectomy, the postoperative:preoperative bodyweight ratio of the SRS group was 2% lower than that of the CRS group. Both groups had comparable total protein and albumin levels, and incidence of reflux esophagitis; however, hemoglobin was lower in the SRS group. This difference in hemoglobin level between the SRS and CRS groups became larger over time, although the total protein and albumin levels of the two groups remained similar.

Conclusion

An SRS slightly decreases bodyweight and hemoglobin level compared with a CRS. Several objective outcomes of the SRS group are almost equal to those of the CRS group, which suggests LsTG is worth performing even though its remnant stomach is very small.

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Funding

The authors have not received Grant support or other forms of assistance.

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Author notes

  1. Itaru Yasufuku and Manabu Ohashi were equally contributed to this work.

Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8551, Japan

    Itaru Yasufuku, Manabu Ohashi, Kojiro Eto, Satoshi Ida, Koshi Kumagai, Souya Nunobe, Takeshi Sano & Naoki Hiki

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  1. Itaru Yasufuku
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  2. Manabu Ohashi
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  3. Kojiro Eto
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Correspondence to Manabu Ohashi.

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Disclosures

Itaru Yasufuku, Manabu Ohashi, Kojiro Eto, Satoshi Ida, Koshi Kumagai, Souya Nunobe, Takeshi Sano, and Naoki Hiki have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. As this study was a retrospective study and did not include any potentially identifiable patient data. The institutional review board gave the ethics approval for this retrospective study.

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Yasufuku, I., Ohashi, M., Eto, K. et al. Size-dependent differences in the proximal remnant stomach: how much does a small remnant stomach after subtotal gastrectomy work?. Surg Endosc 34, 5540–5549 (2020). https://doi.org/10.1007/s00464-019-07353-1

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  • DOI: https://doi.org/10.1007/s00464-019-07353-1

Keywords

  • Gastric cancer
  • Laparoscopic distal gastrectomy
  • Remnant stomach
  • Bodyweight
  • Hemoglobin