Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Sep;15(3):191-200.
doi: 10.5230/jgc.2015.15.3.191. Epub 2015 Sep 30.

Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

Yeon-Ju Huh  1 , Hyuk-Joon Lee  2 , Seung-Young Oh  1 , Kyung-Goo Lee  3 , Jun-Young Yang  4 , Hye-Seong Ahn  5 , Yun-Suhk Suh  1 , Seong-Ho Kong  1 , Kuhn-Uk Lee  3 , Han-Kwang Yang  2
Affiliations

Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

Yeon-Ju Huh et al. J Gastric Cancer. 2015 Sep.

Abstract

Purpose: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC).

Materials and methods: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups.

Results: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001).

Conclusions: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.

Keywords: Gastrectomy; Laparoscopy; Stomach neoplasms.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Differences between conventional proximal gastrectomy (PG) and modified laparoscopy-assisted PG (mLAPG). (A) In conventional PG, the vagus nerve was sacrificed, and pyloroplasty was performed in selective cases. The proximal resection line was made distal to the esophagus. (B) In mLAPG, we aimed to preserve the hepatic branch of the vagus nerve and not perform pyloroplasty. The proximal resection line was made at the gastroesophageal junction.
Fig. 2
Fig. 2. Comparison of overall survival rates between the proximal gastrectomy (PG) and total gastrectomy (TG) groups.
Fig. 3
Fig. 3. Comparison of recurrence-free survival rates between the proximal gastrectomy (PG) and total gastrectomy (TG) groups.
See this image and copyright information in PMC

References

    1. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3) Gastric Cancer. 2011;14:113–123. - PubMed
    1. Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery. 1998;123:127–130. - PubMed
    1. Katsoulis IE, Robotis JF, Kouraklis G, Yannopoulos PA. What is the difference between proximal and total gastrectomy regarding postoperative bile reflux into the oesophagus? Dig Surg. 2006;23:325–330. - PubMed
    1. 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;98:255–260. - PubMed
    1. Hirai T, Matsumoto H, Iki K, Hirabayashi Y, Kawabe Y, Ikeda M, et al. Lower esophageal sphincter- and vagus-preserving proximal partial gastrectomy for early cancer of the gastric cardia. Surg Today. 2006;36:874–878. - PubMed