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Proximal Gastrectomy for Gastric Cancer.

Jung do H, Ahn SH, Park do J, Kim HH - J Gastric Cancer (2015)

Bottom Line: Numerous recent studies have concluded that OPG and LPG present similar oncological safety profiles and improved functional benefits when compared with OTG and LTG.While OPG with modified esophagogastrostomy does not provide satisfactory results, OPG with modified esophagojejunostomy showed similar rates of anastomosis-related late complications when compared to OTG.We recently showed that LPG with double tract reconstruction (DTR) is a superior choice over LTG for proximal EGC in terms of maintaining body weight and preventing anemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT
Laparoscopic proximal gastrectomy (LPG) is theoretically a superior choice of minimally-invasive surgery and function-preserving surgery for the treatment of proximal early gastric cancer (EGC) over procedures such as laparoscopic total gastrectomy (LTG), open total gastrectomy (OTG) and open proximal gastrectomy (OPG). However, LPG and OPG are not popular surgical options due to three main concerns: the first, oncological safety; the second, functional benefits; and the third, anastomosis-related late complications (reflux symptoms and anastomotic stricture). Numerous recent studies have concluded that OPG and LPG present similar oncological safety profiles and improved functional benefits when compared with OTG and LTG. While OPG with modified esophagogastrostomy does not provide satisfactory results, OPG with modified esophagojejunostomy showed similar rates of anastomosis-related late complications when compared to OTG. At this stage, no standard reconstruction method post-LPG exists in the clinical setting. We recently showed that LPG with double tract reconstruction (DTR) is a superior choice over LTG for proximal EGC in terms of maintaining body weight and preventing anemia. However, as there is no definitive evidence in favor of LPG with DTR, a randomized clinical trial comparing LPG with DTR to LTG was recommended. This trial, the Korean Laparoscopic Gastrointestinal Surgery Study-05 (NCT01433861), is expected to assist surgeons in choice of surgical approach and strategy for patients with proximal EGC.

No MeSH data available.


Related in: MedlinePlus

Esophagogastrostomy with gastric tube.
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Figure 2: Esophagogastrostomy with gastric tube.

Mentions: EG stomy is simpler than EJ stomy as it includes only one anastomosis. The feasibilities of many standard and modified EG stomy procedures (e.g., EG stomy with anti-reflux procedures) have been reported, including simple EG stomy (Fig. 1), reverse double stapling,4 lower esophageal sphincter preserving,30 gastric tube (Fig. 2),3132 gastropexy,33 fundoplication (Fig. 3),34 and acute angle EG stomy,28 among others. These EG stomy procedures had a lower surgical duration and decreased estimated blood loss (Table 1). However, these procedures could not demonstrate an acceptable incidence of anastomosis-related late complications. The rates of anastomosis-related late complications were significantly higher after OPG (27.4% to 67.4%) when compared with OTG (7.4% to 8.7%) in several studies comparing EG stomy after OPG with Roux-en-Y EJ stomy after OTG.791135


Proximal Gastrectomy for Gastric Cancer.

Jung do H, Ahn SH, Park do J, Kim HH - J Gastric Cancer (2015)

Esophagogastrostomy with gastric tube.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496445&req=5

Figure 2: Esophagogastrostomy with gastric tube.
Mentions: EG stomy is simpler than EJ stomy as it includes only one anastomosis. The feasibilities of many standard and modified EG stomy procedures (e.g., EG stomy with anti-reflux procedures) have been reported, including simple EG stomy (Fig. 1), reverse double stapling,4 lower esophageal sphincter preserving,30 gastric tube (Fig. 2),3132 gastropexy,33 fundoplication (Fig. 3),34 and acute angle EG stomy,28 among others. These EG stomy procedures had a lower surgical duration and decreased estimated blood loss (Table 1). However, these procedures could not demonstrate an acceptable incidence of anastomosis-related late complications. The rates of anastomosis-related late complications were significantly higher after OPG (27.4% to 67.4%) when compared with OTG (7.4% to 8.7%) in several studies comparing EG stomy after OPG with Roux-en-Y EJ stomy after OTG.791135

Bottom Line: Numerous recent studies have concluded that OPG and LPG present similar oncological safety profiles and improved functional benefits when compared with OTG and LTG.While OPG with modified esophagogastrostomy does not provide satisfactory results, OPG with modified esophagojejunostomy showed similar rates of anastomosis-related late complications when compared to OTG.We recently showed that LPG with double tract reconstruction (DTR) is a superior choice over LTG for proximal EGC in terms of maintaining body weight and preventing anemia.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

ABSTRACT
Laparoscopic proximal gastrectomy (LPG) is theoretically a superior choice of minimally-invasive surgery and function-preserving surgery for the treatment of proximal early gastric cancer (EGC) over procedures such as laparoscopic total gastrectomy (LTG), open total gastrectomy (OTG) and open proximal gastrectomy (OPG). However, LPG and OPG are not popular surgical options due to three main concerns: the first, oncological safety; the second, functional benefits; and the third, anastomosis-related late complications (reflux symptoms and anastomotic stricture). Numerous recent studies have concluded that OPG and LPG present similar oncological safety profiles and improved functional benefits when compared with OTG and LTG. While OPG with modified esophagogastrostomy does not provide satisfactory results, OPG with modified esophagojejunostomy showed similar rates of anastomosis-related late complications when compared to OTG. At this stage, no standard reconstruction method post-LPG exists in the clinical setting. We recently showed that LPG with double tract reconstruction (DTR) is a superior choice over LTG for proximal EGC in terms of maintaining body weight and preventing anemia. However, as there is no definitive evidence in favor of LPG with DTR, a randomized clinical trial comparing LPG with DTR to LTG was recommended. This trial, the Korean Laparoscopic Gastrointestinal Surgery Study-05 (NCT01433861), is expected to assist surgeons in choice of surgical approach and strategy for patients with proximal EGC.

No MeSH data available.


Related in: MedlinePlus