Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of minimally invasive proximal gastrectomy followed by valvuloplastic esophagogastrostomy using the double flap technique in preventing reflux oesophagitis

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Valvuloplastic esophagogastrostomy (VEG) using the double flap technique (DFT) after proximal gastrectomy (PG) represents a promising procedure for the prevention of reflux oesophagitis. We aimed to retrospectively investigate the efficacy of minimally invasive PG followed by VEG-DFT in preventing reflux oesophagitis among patients who require intra-mediastinal anastomosis.

Methods

A total of 80 patients who underwent reconstruction with DFT after LPG from November 2013 to January 2021 were enrolled in the present study. Data were obtained through a review of our prospectively maintained database. At 1 year after surgery, multivariate analyses were performed to identify risk factors for gastroesophageal reflux disease of Los Angeles (LA) classification grade B or higher.

Results

The incidence of LA grade B or higher reflux oesophagitis 1 year after surgery was 10%. Multivariate analyses revealed that the longitudinal length of the resected oesophagus of > 20 mm was the only significant risk factor for reflux oesophagitis. Patients with a longitudinal length of the resected oesophagus > 20 mm (group-L, n = 35) had a significantly longer total operative time and a higher rate of complications within 30 days of surgery than those with a length of ≤ 20 mm (group-S, n = 45). LA grade B or higher reflux oesophagitis was significantly higher in group-L than in group-S (20% vs. 2.2%; P = 0.011).

Conclusions

There is a need for surgical procedures with improved efficacy for the prevention of reflux oesophagitis in patients requiring oesophageal resection of > 20-mm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 24:1–21.

  2. Tokunaga M, Ohyama S, Hiki N, Hoshino E, Nunobe S, Fukunaga T et al (2008) Endoscopic evaluation of reflux esophagitis after proximal gastrectomy: comparison between esophagogastric anastomosis and jejunal interposition. World J Surg 32(7):1473–1477

    Article  PubMed  Google Scholar 

  3. Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S et al (2016) Double flap technique as an anti-reflux procedure in esophagogastrostomy after proximal gastrectomy. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2016.04.041

    Article  PubMed  Google Scholar 

  4. Kuroda S, Choda Y, Otsuka S, Ueyama S, Tanaka N, Muraoka A et al (2019) Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study). Ann Gastroenterol Surg 3(1):96–103

    Article  PubMed  Google Scholar 

  5. Shoji Y, Nunobe S, Ida S, Kumagai K, Ohashi M, Sano T et al (2019) Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer. Gastric Cancer 22(5):1036–1043

    Article  PubMed  Google Scholar 

  6. Saze Z, Kase K, Nakano H, Yamauchi N, Kaneta A, Watanabe Y et al (2021) Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer. BMC Surg 21(1):392

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hosoda K, Yamashita K, Moriya H, Mieno H, Ema A, Washio M et al (2017) Laparoscopically assisted proximal gastrectomy with esophagogastrostomy using a novel “Open-Door” technique : LAPG with novel reconstruction. J gastrointest surg 21(7):1174–1180

    Article  PubMed  Google Scholar 

  8. Kurokawa Y, Takeuchi H, Doki Y, Mine S, Terashima M, Yasuda T et al (2019) Mapping of lymph node metastasis from esophagogastric junction tumors: a prospective nationwide multicenter study. Ann surg. https://doi.org/10.2139/ssrn.3321496

    Article  PubMed  Google Scholar 

  9. Uyama I, Suda K, Satoh S (2013) Laparoscopic surgery for advanced gastric cancer: current status and future perspectives. J gastric cancer 13(1):19–25

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shibasaki S, Suda K, Nakauchi M, Nakamura K, Kikuchi K, Inaba K et al (2020) Non-robotic minimally invasive gastrectomy as an independent risk factor for postoperative intra-abdominal infectious complications: a single-center, retrospective and propensity score-matched analysis. World J Gastroenterol 26(11):1172–1184

    Article  PubMed  PubMed Central  Google Scholar 

  11. Shinohara T, Satoh S, Kanaya S, Ishida Y, Taniguchi K, Isogaki J et al (2013) Laparoscopic versus open D2 gastrectomy for advanced gastric cancer: a retrospective cohort study. Surg Endosc 27(1):286–294

    Article  PubMed  Google Scholar 

  12. Nakauchi M, Suda K, Kadoya S, Inaba K, Ishida Y, Uyama I (2016) Technical aspects and short- and long-term outcomes of totally laparoscopic total gastrectomy for advanced gastric cancer: a single-institution retrospective study. Surg Endosc 30(10):4632–4639

    Article  PubMed  Google Scholar 

  13. Shibasaki S, Suda K, Nakauchi M, Kikuchi K, Kadoya S, Ishida Y et al (2017) Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes. Surg Endosc 31(10):4283–4297

    Article  PubMed  Google Scholar 

  14. Yamashita Y, Tatsubayashi T, Okumura K, Miyamoto T, Ueno K (2022) Modified side overlap esophagogastrostomy after laparoscopic proximal gastrectomy. Ann Gastroenterol Surg 6(4):594–599

    Article  PubMed  PubMed Central  Google Scholar 

  15. Nakauchi M, Suda K, Shibasaki S, Nakamura K, Kadoya S, Kikuchi K et al (2021) Prognostic factors of minimally invasive surgery for gastric cancer: does robotic gastrectomy bring oncological benefit? World J Gastroenterol 27(39):6659–6672

    Article  PubMed  PubMed Central  Google Scholar 

  16. Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer: Official Journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association. 20(1):1–19

  17. Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S (2012) Novel integrated robotic approach for suprapancreatic D2 nodal dissection for treating gastric cancer: technique and initial experience. World J Surg 36(2):331–337

    Article  PubMed  Google Scholar 

  18. Suzuki K, Shibasaki S, Nakauchi M, Nakamura K, Akimoto S, Tanaka T et al (2021) Impact of routine preoperative sonographic screening with early intervention for deep venous thrombosis in lower extremities on preventing postoperative venous thromboembolism in patients with gastric cancer scheduled for minimally invasive surgery. Langenbeck’s arch surg. https://doi.org/10.1007/s00423-021-02315-5

    Article  Google Scholar 

  19. Suda K, Man IM, Ishida Y, Kawamura Y, Satoh S, Uyama I (2015) Potential advantages of robotic radical gastrectomy for gastric adenocarcinoma in comparison with conventional laparoscopic approach: a single institutional retrospective comparative cohort study. Surg Endosc 29(3):673–685

    Article  PubMed  Google Scholar 

  20. Uyama I, Suda K, Nakauchi M, Kinoshita T, Noshiro H, Takiguchi S et al (2019) Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer 22(2):377–385

    Article  PubMed  Google Scholar 

  21. Shibasaki S, Suda K, Nakauchi M, Nakamura K, Tanaka T, Kikuchi K et al (2021) Impact of the endoscopic surgical skill qualification system on the safety of laparoscopic gastrectomy for gastric cancer. Surg Endosc 35(11):6089–6100

    Article  PubMed  Google Scholar 

  22. Shibasaki S, Suda K, Kadoya S, Ishida Y, Nakauchi M, Nakamura K et al (2022) The safe performance of robotic gastrectomy by second-generation surgeons meeting the operating surgeon’s criteria in the Japan society for endoscopic surgery guidelines. Asian j endoscop surg 15(1):70–81

    Article  Google Scholar 

  23. Nakamura K, Suda K, Shibasaki S, Nakauchi M, Kikuchi K, Inaba K et al (2020) The hepatic left lateral segment inverting method offering a wider operative field of view during laparoscopic proximal gastrectomy. J gastrointest surg 24(10):2395–2403

    Article  PubMed  Google Scholar 

  24. Nakauchi M, Suda K, Nakamura K, Shibasaki S, Kikuchi K, Nakamura T et al (2017) Laparoscopic subtotal gastrectomy for advanced gastric cancer: technical aspects and surgical, nutritional and oncological outcomes. Surg Endosc 31(11):4631–4640

    Article  PubMed  Google Scholar 

  25. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP et al (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los angeles classification. Gut 45(2):172–180

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD et al (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    Article  PubMed  Google Scholar 

  27. Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N et al (2016) Extended Clavien–Dindo classification of surgical complications: Japan clinical oncology group postoperative complications criteria. Surg Today 46(6):668–685

    Article  PubMed  Google Scholar 

  28. Omori T, Yamamoto K, Yanagimoto Y, Shinno N, Sugimura K, Takahashi H et al (2021) A Novel Valvuloplastic esophagogastrostomy technique for laparoscopic transhiatal lower esophagectomy and proximal gastrectomy for Siewert type II esophagogastric junction carcinoma-the tri double-flap hybrid method. J gastrointest surg 25(1):16–27

    Article  PubMed  Google Scholar 

  29. Nakamura M, Yamaue H (2015) Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014. Surg today. https://doi.org/10.1007/s00595-015-1185-4

    Article  PubMed  PubMed Central  Google Scholar 

  30. Okabe H, Obama K, Tanaka E, Tsunoda S, Akagami M, Sakai Y (2013) Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric Cancer 16(2):268–274

    Article  PubMed  Google Scholar 

  31. Nakamura M, Nakamori M, Ojima T, Katsuda M, Iida T, Hayata K et al (2014) Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: an analysis of our 13-year experience. Surgery 156(1):57–63

    Article  PubMed  Google Scholar 

  32. Sakuramoto S, Yamashita K, Kikuchi S, Futawatari N, Katada N, Moriya H 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(3):344–351

    Article  PubMed  Google Scholar 

  33. Yasuda A, Yasuda T, Imamoto H, Kato H, Nishiki K, Iwama M et al (2015) A newly modified esophagogastrostomy with a reliable angle of his by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy. Gastric Cancer 18(4):850–858

    Article  PubMed  Google Scholar 

  34. Nunobe S, Ida S (2020) Current status of proximal gastrectomy for gastric and esophagogastric junctional cancer: a review. Ann Gastroenterol Surg 4(5):498–504

    Article  PubMed  PubMed Central  Google Scholar 

  35. Mine S, Kurokawa Y, Takeuchi H, Terashima M, Yasuda T, Yoshida K et al (2022) Postoperative complications after a transthoracic esophagectomy or a transhiatal gastrectomy in patients with esophagogastric junctional cancers: a prospective nationwide multicenter study. Gastric Cancer 25(2):430–437

    Article  PubMed  Google Scholar 

  36. Shibasaki S, Nakauchi M, Serizawa A, Nakamura K, Akimoto S, Tanaka T et al (2022) Clinical advantage of standardized robotic total gastrectomy for gastric cancer: a single-center retrospective cohort study using propensity-score matching analysis. Gastric Cancer 25(4):804–816

    Article  CAS  PubMed  Google Scholar 

  37. Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N et al (2019) Single-arm confirmatory trial of laparoscopy-assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan clinical oncology group study JCOG1401. Gastric Cancer 22(5):999–1008

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank MARUZEN-YUSHODO Co., Ltd. (https://kw.maruzen.co.jp/kousei-honyaku/) for English language editing.

Author information

Authors and Affiliations

  1. Department of Surgery, Okazaki Medical Center, Fujita Health University, 1 Gotanda, Harusaki, Okazaki, Aichi, 444-0827, Japan

    Kazuhiro Matsuo

  2. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Kazuhiro Matsuo, Susumu Shibasaki, Kazumitsu Suzuki, Akiko Serizawa, Shingo Akimoto, Tsuyoshi Tanaka & Koichi Suda

  3. Department of Advanced Robotic and Endoscopic Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Masaya Nakauchi, Kazuki Inaba & Ichiro Uyama

  4. Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Ichiro Uyama

  5. Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Koichi Suda

Authors
  1. Kazuhiro Matsuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susumu Shibasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazumitsu Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Akiko Serizawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shingo Akimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaya Nakauchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tsuyoshi Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuki Inaba
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ichiro Uyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Koichi Suda
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors have fully met the ICMJE authorship criteria and contributed to the present manuscript as follows: study design, KM, SS, IU and KS; data collection, KM, SS, KS, AS, MN and TT; statistical analysis and interpretation of results, KM, SS, MN, KI and KS; drafting of the manuscript, KM, SS and KS; critical revision of the manuscript for important intellectual content, SS, IU and KS. All authors read and approved the final manuscript. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Susumu Shibasaki.

Ethics declarations

Disclosures

Kazuhiro Matsuo, Susumu Shibasaki, Kazumitsu Suzuki, Akiko Serizawa, Shingo Akimoto, Masaya Nakauchi, Tsuyoshi Tanaka, Kazuki Inaba, Ichiro Uyama and Koichi Suda have no commercial association with or financial involvement that might be construed as a conflict of interest in connection with the submitted article. Ichiro Uyama has received lecture fees from Intuitive Surgical, Inc. outside of the submitted work. Tsuyoshi Tanaka and Ichiro Uyama have been funded by Medicaroid, Inc. in relation to the Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University. Koichi Suda has been funded by Sysmex Corp. in relation to the Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University and has also received advisory fees from Medicaroid, Inc. outside of the submitted work.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Matsuo, K., Shibasaki, S., Suzuki, K. et al. Efficacy of minimally invasive proximal gastrectomy followed by valvuloplastic esophagogastrostomy using the double flap technique in preventing reflux oesophagitis. Surg Endosc 37, 3478–3491 (2023). https://doi.org/10.1007/s00464-022-09840-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09840-4

Keywords

Search

Navigation