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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

Esophagojejunostomy: double tract reconstruction.
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Figure 5: Esophagojejunostomy: double tract reconstruction.

Mentions: Many modified EJ stomy procedures have been tried in place of an EG stomy in an effort to prevent anastomosis-related late complications, including jejunal interposition (Fig. 4),610151619202136373839404142 jejunal pouch interposition,202529383943444546 double tract reconstruction (DTR) (Fig. 5),47 and more (Table 2). The incidence of anastomosis-related late complications was not significantly different when comparing modified EJ stomy after OPG (0% to 10.2%) and Rouxen-Y EJ stomy after OTG (1.8% to 8.7%).6113638 Thus, most modified EJ stomy procedures are considered a good reconstruction method in terms of preventing reflux esophagitis and anastomotic stenosis.


Proximal Gastrectomy for Gastric Cancer.

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

Esophagojejunostomy: double tract reconstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Esophagojejunostomy: double tract reconstruction.
Mentions: Many modified EJ stomy procedures have been tried in place of an EG stomy in an effort to prevent anastomosis-related late complications, including jejunal interposition (Fig. 4),610151619202136373839404142 jejunal pouch interposition,202529383943444546 double tract reconstruction (DTR) (Fig. 5),47 and more (Table 2). The incidence of anastomosis-related late complications was not significantly different when comparing modified EJ stomy after OPG (0% to 10.2%) and Rouxen-Y EJ stomy after OTG (1.8% to 8.7%).6113638 Thus, most modified EJ stomy procedures are considered a good reconstruction method in terms of preventing reflux esophagitis and anastomotic stenosis.

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