Abstract
BackgroundThe optimal reconstruction method after proximal gastrectomy (PG) has been debatable. Recent reports have shown that the double-flap technique (DFT) provides good outcomes in terms of postoperative nutritional status and quality of life. However, no study has compared the clinical outcomes of the DFT with other reconstruction methods. Here, we evaluated and compared the clinical outcomes between the DFT and jejunal interposition (JI) after PG for gastric cancer.Materials and methodsThe medical records of 34 consecutive patients who had undergone PG for upper third gastric cancer between January 2011 and October 2016 were reviewed retrospectively. The main factors investigated were surgical outcomes, postoperative nutritional status, symptoms, and endoscopic findings 1 year after surgery.ResultsThirty-four patients were enrolled (DFT, 14; JI, 20). The operation time was similar between the two techniques (228 and 246 minutes for DFT and JI, respectively, P = 0.377), as were the rates of anastomotic complications (7% and 0% for DFT and JI, respectively, P = 0.412). Body weight loss was significantly lower in the DFT group than in the JI group (-8.1% vs -16.1%, P = 0.001). Total protein and albumin levels were higher in the DFT group than in the JI group (0% vs -2.9%, P = 0.053, and -0.3% vs -6.1%, P = 0.077, respectively). One patient in the DFT group and no patients in the JI group experienced reflux esophagitis (≥ grade B) (P = 0.393). Anastomotic strictures were not observed as postoperative complications in either group.ConclusionsSurgical outcomes revealed that the DFT was safe and feasible, similar to JI. In terms of controlling postoperative body weight loss, the DFT is a better reconstruction technique than JI after PG.
Highlights
Body weight loss was significantly lower in the double-flap technique (DFT) group than in the jejunal interposition (JI) group (-8.1% vs -16.1%, P = 0.001)
Total protein and albumin levels were higher in the DFT group than in the JI group (0% vs -2.9%, P = 0.053, and -0.3% vs -6.1%, P = 0.077, respectively)
Surgical outcomes revealed that the DFT was safe and feasible, similar to JI
Summary
Postoperative body weight loss always occurs in patients undergoing gastrectomy for gastric cancer, and the significant decrease in body weight and sarcopenia after gastrectomy are negatively associated with long-term survival [1, 2]. Some surgeons remain reluctant to perform PG, even for early gastric cancer in the upper third of the stomach This is because simple esophagogastrostomy after PG, which was first described in 1898 [6], is closely associated with reflux esophagitis, which has been the major critical point as it often leads to a decreased dietary intake and a deterioration in the quality of life (QOL) [7]. To overcome this problem, several reconstruction methods such as jejunal interposition (JI) and double-tract reconstruction have been devised and used after PG. We evaluated and compared the clinical outcomes between the DFT and jejunal interposition (JI) after PG for gastric cancer
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