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Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 17 May 2018

This article has been updated

Abstract

Background

A novel double-flap esophagogastrostomy technique developed to prevent reflux after proximal gastrectomy was applied to laparoscopic proximal gastrectomy (LPG), and the clinical outcomes of this technique (LPG-DFT) were evaluated and compared to those of laparoscopic total gastrectomy (LTG).

Methods

This retrospective study of 90 patients with early gastric cancer (EGC) in the upper third of the stomach compared surgical outcomes, postoperative endoscopic findings, and nutritional status between two procedure groups, LPG-DFT (n = 43) and LTG (n = 47). The association between morbidity and surgical procedure was analyzed by controlling for body mass index (BMI).

Results

Mean operation time was significantly higher for LPG-DFT than LTG (386.5 vs. 316.3 min, P < 0.001). The morbidity and the frequency of anastomotic complications were lower, although not significantly, for LPG-DFT than LTG (7.0 vs. 21.3%, P = 0.073; and 4.7 vs. 17.2%, P = 0.093). Median postoperative hospital stay was significantly shorter for LPG-DFT than LTG (10 vs. 13 days, P = 0.002). The LPG-DFT procedure was identified as the most significant independent predictor of low morbidity after adjustment for BMI (P = 0.028, OR = 0.232, 95% CI 0.047–0.862). LTG induced more severe reflux esophagitis than LPG-DFT (14.9% vs. 2.3%, P = 0.06). The mean baseline weight, total protein, and hemoglobin were significantly higher with LPG-DFT than with LTG (P < 0.05).

Conclusions

LPG-DFT is a better surgical procedure for treating upper-third EGC than LTG in terms of morbidity, postoperative hospital stay, and postoperative nutritional status.

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Change history

  • 17 May 2018

    In the original article on page 1636, first line, the reference cited for Kamikawa et al. is incorrect. The correct reference is as follows: Kamikawa YKT, Kamiyama S, Satomoto K. A new procedure of esophagogastrostomy to prevent reflux following proximal gastrectomy (in Japanese). Shoukakigeka. 2001;24:1053–60.

  • 17 May 2018

    In the original article on page 1636, first line, the reference cited for Kamikawa et al. is incorrect. The correct reference is as follows: Kamikawa Y, Kobayashi T, Kamiyama S, et al. A new procedure of esophagogastrostomy to prevent reflux following proximal gastrectomy (in Japanese). Shoukakigeka. 2001;24:1053?60.

  • 17 May 2018

    In the original article on page 1636, first line, the reference cited for Kamikawa et al. is incorrect. The correct reference is as follows: Kamikawa Y, Kobayashi T, Kamiyama S, et al. A new procedure of esophagogastrostomy to prevent reflux following proximal gastrectomy (in Japanese). Shoukakigeka. 2001;24:1053?60.

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Acknowledgement

The authors would like to thank Dr. Naoki Ishizuka for his statistical advice and for always taking the time to read this manuscript and respond rapidly with valuable suggestions for improvements.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Masaru Hayami MD, PhD, Naoki Hiki MD, PhD, Souya Nunobe MD, PhD, Shinji Mine MD, Manabu Ohashi MD, PhD, Koshi Kumagai MD, PhD, Satoshi Ida MD, PhD, Masayuki Watanabe MD, PhD, Takeshi Sano MD, PhD & Toshiharu Yamaguchi MD, PhD

Authors
  1. Masaru Hayami MD, PhD
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  2. Naoki Hiki MD, PhD
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  3. Souya Nunobe MD, PhD
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  4. Shinji Mine MD
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  5. Manabu Ohashi MD, PhD
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  6. Koshi Kumagai MD, PhD
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  7. Satoshi Ida MD, PhD
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  8. Masayuki Watanabe MD, PhD
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  9. Takeshi Sano MD, PhD
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  10. Toshiharu Yamaguchi MD, PhD
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Corresponding author

Correspondence to Naoki Hiki MD, PhD.

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Hayami, M., Hiki, N., Nunobe, S. et al. Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach. Ann Surg Oncol 24, 1635–1642 (2017). https://doi.org/10.1245/s10434-017-5782-x

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  • DOI: https://doi.org/10.1245/s10434-017-5782-x

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