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Consideration of cardia preserving proximal gastrectomy in early gastric cancer of upper body for prevention of gastroesophageal reflux disease and stenosis of anastomosis site.

Kim J, Kim S, Min YD - J Gastric Cancer (2012)

Bottom Line: The length of proximal resection free margin was 3.1±0.1 cm and distal was 3.7±0.1 cm.Early complications were surgical site infection (1), bleeding (1), and gastro-esophageal reflux disease (1) (this symptom was improved with medication).Late complications were dyspepsia (3) (this symptom was improved without any treatment), and others were nonspecific results of endoscopy or symptom.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chosun University College of Medicine, Gwangju, Korea.

ABSTRACT

Purpose: The aim of this study is to evaluate the feasibility and safety of cardia preserving proximal gastrectomy, in early gastric cancer of the upper third.

Materials and methods: A total of 10 patients were diagnosed with early gastric cancer of the upper third through endoscopic biopsy. The operation time, length of resection free margin, number of resected lymph nodes and postoperative complications, gastrointestinal symptoms, nutritional status, anastomotic stricture, and recurrence were examined.

Results: There were 5 males and 5 females. The mean age was 56.5±0.5 years. The mean operation time was 188.5±0.5 minutes (laparoscopic operation was 270 minutes). Nine patients were T1 stage (T2 : 1), and N stage was all N0. The mean number of resected lymph nodes was 25.2±0.5. The length of proximal resection free margin was 3.1±0.1 cm and distal was 3.7±0.1 cm. Early complications were surgical site infection (1), bleeding (1), and gastro-esophageal reflux disease (1) (this symptom was improved with medication). Late complications were dyspepsia (3) (this symptom was improved without any treatment), and others were nonspecific results of endoscopy or symptom.

Conclusions: Cardia preserving proximal gastrectomy was feasible for early gastric cancer of the upper third. Further evaluation and prospective research will be required.

No MeSH data available.


Related in: MedlinePlus

Final configuration of anastomosis with suture lines after cardia preserving proximal gastrectomy.
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Figure 3: Final configuration of anastomosis with suture lines after cardia preserving proximal gastrectomy.

Mentions: The abdominal esophagus was not widely dissected to avoid damage of PEL on the diaphragm, and the palpated lymph nodes without complete separation, like the 5th, and the 6th lymph nodes were excised on perigastric lymph nodes (1st and 2nd lymph nodes) in the cardia. After confirming that the metastasis was not discovered through a frozen biopsy, an excision was performed about 2 cm from the bottom to the top on E-G junction and securing the proximal free resection margin was confirmed through a frozen biopsy. The CPPG was not intended to proceed any more in case of selectively separating the abovementioned lymph nodes and suspicious of metastasis on the lymph nodes. Then, the lymph nodes dissection, in accordance with D1+b was performed by dissecting the lymph nodes around the celiac artery. The anastomosis of remaining stomach with layers, mucosa-submucosa and sero-muscular suture, was performed by hand for laparotomy, and the gastro-gastrostomy was performed by linear stapler in case of the laparoscopic surgery (Fig. 2, 3). The pyloroplasty was not performed and the nasogastric tube was not inserted. The oral intake started from the 4th day after the surgery.


Consideration of cardia preserving proximal gastrectomy in early gastric cancer of upper body for prevention of gastroesophageal reflux disease and stenosis of anastomosis site.

Kim J, Kim S, Min YD - J Gastric Cancer (2012)

Final configuration of anastomosis with suture lines after cardia preserving proximal gastrectomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473226&req=5

Figure 3: Final configuration of anastomosis with suture lines after cardia preserving proximal gastrectomy.
Mentions: The abdominal esophagus was not widely dissected to avoid damage of PEL on the diaphragm, and the palpated lymph nodes without complete separation, like the 5th, and the 6th lymph nodes were excised on perigastric lymph nodes (1st and 2nd lymph nodes) in the cardia. After confirming that the metastasis was not discovered through a frozen biopsy, an excision was performed about 2 cm from the bottom to the top on E-G junction and securing the proximal free resection margin was confirmed through a frozen biopsy. The CPPG was not intended to proceed any more in case of selectively separating the abovementioned lymph nodes and suspicious of metastasis on the lymph nodes. Then, the lymph nodes dissection, in accordance with D1+b was performed by dissecting the lymph nodes around the celiac artery. The anastomosis of remaining stomach with layers, mucosa-submucosa and sero-muscular suture, was performed by hand for laparotomy, and the gastro-gastrostomy was performed by linear stapler in case of the laparoscopic surgery (Fig. 2, 3). The pyloroplasty was not performed and the nasogastric tube was not inserted. The oral intake started from the 4th day after the surgery.

Bottom Line: The length of proximal resection free margin was 3.1±0.1 cm and distal was 3.7±0.1 cm.Early complications were surgical site infection (1), bleeding (1), and gastro-esophageal reflux disease (1) (this symptom was improved with medication).Late complications were dyspepsia (3) (this symptom was improved without any treatment), and others were nonspecific results of endoscopy or symptom.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chosun University College of Medicine, Gwangju, Korea.

ABSTRACT

Purpose: The aim of this study is to evaluate the feasibility and safety of cardia preserving proximal gastrectomy, in early gastric cancer of the upper third.

Materials and methods: A total of 10 patients were diagnosed with early gastric cancer of the upper third through endoscopic biopsy. The operation time, length of resection free margin, number of resected lymph nodes and postoperative complications, gastrointestinal symptoms, nutritional status, anastomotic stricture, and recurrence were examined.

Results: There were 5 males and 5 females. The mean age was 56.5±0.5 years. The mean operation time was 188.5±0.5 minutes (laparoscopic operation was 270 minutes). Nine patients were T1 stage (T2 : 1), and N stage was all N0. The mean number of resected lymph nodes was 25.2±0.5. The length of proximal resection free margin was 3.1±0.1 cm and distal was 3.7±0.1 cm. Early complications were surgical site infection (1), bleeding (1), and gastro-esophageal reflux disease (1) (this symptom was improved with medication). Late complications were dyspepsia (3) (this symptom was improved without any treatment), and others were nonspecific results of endoscopy or symptom.

Conclusions: Cardia preserving proximal gastrectomy was feasible for early gastric cancer of the upper third. Further evaluation and prospective research will be required.

No MeSH data available.


Related in: MedlinePlus