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Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer

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Abstract

Background

Laparoscopic proximal gastrectomy (LPG) with double tract reconstruction (DTR) is known to reduce reflux symptoms, which is a major concern after proximal gastrectomy. The aim of this study is to compare retrospectively the clinical outcomes of patients undergoing LPG with DTR with those treated by laparoscopic total gastrectomy (LTG).

Methods

Ninety-two and 156 patients undergoing LPG with DTR and LTG for proximal stage I gastric cancer were retrospectively analyzed for short- and long-term clinical outcomes.

Results

There were no significant differences in the demographics, T-stage, N-stage, and complications between the groups. The LPG with DTR group had a shorter operative time and lower estimated blood loss than the LTG group (198.3 vs. 225.4 min, p < 0.001; and 84.7 vs. 128.3 mL p = 0.001). The incidence of reflux symptoms ≥ Visick grade II did not significantly differ between the groups during a mean follow-up period of 37.2 months (1.1 vs. 1.9%, p = 0.999). The hemoglobin change was significantly lower in the LPG with DTR group compared to in the LTG group in the first and second postoperative years (5.03 vs. 9.18% p = 0.004; and 3.45 vs. 8.30%, p = 0.002, respectively), as was the mean amount of vitamin B12 supplements 2 years after operation (0.1 vs. 3.1 mg, p < 0.001). The overall survival rate was similar between the groups.

Conclusions

LPG with DTR maintained comparable oncological safety and anastomosis-related late complications compared to LTG and is preferred over LTG in terms of preventing postoperative anemia and vitamin B12 deficiency.

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Acknowledgement

The authors have been awarded the research grant from Korean National Strategic Coordinating Center of Clinical Research (Grant No.: HI10V0084010014).

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Author notes

  1. Do Hyun Jung

    Present address: Department of Surgery, Korea University College of Medicine, Seoul, Republic of Korea

Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyenggi-do, 13620, Republic of Korea

    Do Hyun Jung, Yoontaek Lee, Dong Wook Kim, Young Suk Park, Sang-Hoon Ahn, Do Joong Park & Hyung-Ho Kim

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  1. Do Hyun Jung
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Correspondence to Do Joong Park.

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Do Hyun Jung, Yoontaek Lee, Dong Wook Kim, Young Suk Park, Sang-Hoon Ahn, Do Joong Park and Hyung-Ho Kim have no conflicts of interest or financial ties to disclose.

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Jung, D.H., Lee, Y., Kim, D.W. et al. Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer. Surg Endosc 31, 3961–3969 (2017). https://doi.org/10.1007/s00464-017-5429-9

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  • DOI: https://doi.org/10.1007/s00464-017-5429-9

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