Annals of Surgical Oncology

, Volume 22, Supplement 3, pp 929–935 | Cite as

Feasibility and Nutritional Benefits of Laparoscopic Proximal Gastrectomy for Early Gastric Cancer in the Upper Stomach

  • Toshiyuki Kosuga
  • Daisuke IchikawaEmail author
  • Shuhei Komatsu
  • Kazuma Okamoto
  • Hirotaka Konishi
  • Atsushi Shiozaki
  • Hitoshi Fujiwara
  • Eigo Otsuji
Gastrointestinal Oncology



Laparoscopic proximal gastrectomy (LPG) has recently been applied for early gastric cancer (EGC) in the upper stomach as a minimally invasive and function-preserving surgery. This study aimed to clarify the feasibility and nutritional benefits of LPG over laparoscopic total gastrectomy (LTG).


This was a retrospective study of 77 patients with clinical stage I gastric cancer in the upper stomach. Of these patients, 25 underwent LPG, while 52 underwent LTG. Surgical outcomes and postoperative nutritional status such as changes in body weight and blood chemistries were compared between LPG and LTG.


Intraoperative blood loss and C-reactive protein levels at 3 and 7 days after surgery were significantly lower in LPG than in LTG (p = 0.018, 0.036, and 0.042, respectively). No significant differences were observed in postoperative early or late complication rates between LPG and LTG. The incidence of Los Angeles Grade B or more severe reflux esophagitis after LPG was 9.1 %, which was similar to that after LTG (9.3 %). Postoperative changes in body weight at 6 months and 1 and 2 years after surgery were consistently less in LPG than in LTG (p = 0.001, 0.022, and 0.001, respectively). Moreover, postoperative levels of hemoglobin and serum albumin and total lymphocyte count were also higher in LPG than in LTG.


LPG may be a better choice for EGC in the upper stomach than LTG because it has distinct advantages in terms of surgical invasiveness and postoperative nutritional status.


Early Gastric Cancer Reflux Esophagitis Anastomotic Stricture Remnant Stomach Laparoscopic Gastrectomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Toshiyuki Kosuga, Daisuke Ichikawa, Shuhei Komatsu, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, and Eigo Otsuji declare that they have no conflicts of interest.

Supplementary material

10434_2015_4590_MOESM1_ESM.docx (1.2 mb)
Supplementary material 1 (DOCX 101 kb)
10434_2015_4590_MOESM2_ESM.docx (102 kb)
Supplementary material 2 (DOCX 109 kb)
10434_2015_4590_MOESM3_ESM.docx (110 kb)
Supplementary material 3 (DOCX 1249 kb)


  1. 1.
    Okabayashi T, Gotoda T, Kondo H, Inui T, Ono H, Saito D, et al. Early carcinoma of the gastric cardia in Japan: is it different from that in the West? Cancer. 2000;89(12):2555–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg. 2011;98(2):255–60.PubMedCrossRefGoogle Scholar
  3. 3.
    Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery. 1998;123(2):127–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, et al. Long-term outcomes of patients who underwent limited proximal gastrectomy. Gastric Cancer. 2014;17(1):141–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg. 2010;97(4):558–62.PubMedCrossRefGoogle Scholar
  6. 6.
    Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg. 2007;245(1):68–72.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Ahn SH, Lee JH, Park do J, Kim HH. Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer. 2013;16(3):282–9.PubMedCrossRefGoogle Scholar
  8. 8.
    An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg. 2008;196(4):587–91.PubMedCrossRefGoogle Scholar
  9. 9.
    Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E. Esophagogastrostomy using a circular stapler in laparoscopy-assisted proximal gastrectomy with an incision in the left abdomen. Langenbecks Arch Surg. 2012;397(1):57–62.PubMedCrossRefGoogle Scholar
  10. 10.
    Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E. Evaluation of symptoms related to reflux esophagitis in patients with esophagogastrostomy after proximal gastrectomy. Langenbecks Arch Surg. 2013;398(5):697–701.PubMedCrossRefGoogle Scholar
  11. 11.
    Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRefGoogle Scholar
  12. 12.
    Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.Google Scholar
  13. 13.
    Nunobe S, Hiki N, Tanimura S, Kubota T, Kumagai K, Sano T, et al. Three-step esophagojejunal anastomosis with atraumatic anvil insertion technique after laparoscopic total gastrectomy. J Gastrointest Surg. 2011;15(9):1520–5.PubMedCrossRefGoogle Scholar
  14. 14.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.PubMedCrossRefGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Takiguchi N, Takahashi M, Ikeda M, Inagawa S, Ueda S, Nobuoka T, et al. 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. 2015;18(2):407–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Ichikawa D, Ueshima Y, Shirono K, Kan K, Shioaki Y, Lee CJ, et al. Esophagogastrostomy reconstruction after limited proximal gastrectomy. Hepatogastroenterology. 2001;48(42):1797–801.PubMedGoogle Scholar
  18. 18.
    Nakamura M, Nakamori M, Ojima T, Katsuda M, Iida T, Hayata K, et al. Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: an analysis of our 13-year experience. Surgery. 2014;156(1):57–63.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee JH, Hyung WJ, Kim HI, Kim YM, Son T, Okumura N, et al. Method of reconstruction governs iron metabolism after gastrectomy for patients with gastric cancer. Ann Surg. 2013;258(6):964–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Hu Y, Kim HI, Hyung WJ, Song KJ, Lee JH, Kim YM, et al. Vitamin B(12) deficiency after gastrectomy for gastric cancer: an analysis of clinical patterns and risk factors. Ann Surg. 2013;258(6):970–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Kosuga T, Hiki N, Nunobe S, Noma H, Honda M, Tanimura S, et al. Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol. 2014;21(6):2028–35.PubMedCrossRefGoogle Scholar
  22. 22.
    Izaks GJ, Remarque EJ, Becker SV, Westendorp RG. Lymphocyte count and mortality risk in older persons. The Leiden 85-Plus Study. J Am Geriatr Soc. 2003;51(10):1461–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Watanabe M, Iwatsuki M, Iwagami S, Ishimoto T, Baba Y, Baba H. Prognostic nutritional index predicts outcomes of gastrectomy in the elderly. World J Surg. 2012;36(7):1632–9.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Toshiyuki Kosuga
    • 1
  • Daisuke Ichikawa
    • 1
    Email author
  • Shuhei Komatsu
    • 1
  • Kazuma Okamoto
    • 1
  • Hirotaka Konishi
    • 1
  • Atsushi Shiozaki
    • 1
  • Hitoshi Fujiwara
    • 1
  • Eigo Otsuji
    • 1
  1. 1.Division of Digestive Surgery, Department of SurgeryKyoto Prefectural University of MedicineKyotoJapan

Personalised recommendations