Abstract
BackgroundWe invented a new antireflux anastomosis method for use in proximal gastrectomy for adenocarcinoma of the esophagogastric junction (AEG) and named it semi-embedded valve anastomosis (SEV). This study was conducted to compare and analyze the short-term efficacy and long-term prognosis of this anastomosis reconstruction method versus laparoscopic total gastrectomy (LTG).MethodsWe retrospectively analyzed the general data and surgical outcomes of patients with AEG who underwent three united laparoscopic proximal gastrectomy plus semi-embedded valve anastomosis (TULPG-SEV, N = 20) and LTG (N = 20) at our hospital from January 2015 to September 2017 and investigated the incidence of postoperative reflux esophagitis and postoperative nutritional status between the two groups. Survival analysis was also performed.ResultsThe operative time (178.25 ± 15.41 vs 196.5 ± 21.16 min) and the gastrointestinal reconstruction time (19.3 ± 2.53 vs 34.65 ± 4.88 min) of the TULPG-SEV group were significantly less than that of the LTG group. There was no difference in intraoperative blood loss, length of hospital stay, and postoperative complications. There was no difference in the scores on the postoperative reflux disease questionnaires (RDQs) conducted 1 month (P = 0.501), 3 months (P = 0.238), and 6 months (P = 0.655) after surgery between the TULPG-SEV group and LTG group. Gastroscopy revealed 2 cases of reflux esophagitis (grade B or higher) in each group. The postoperative hemoglobin level was better in the TULPG-SEV group than in the LTG group, and the difference was most noticeable at 1 month after surgery (P = 0.024) and 3 months after surgery (P = 0.029). The levels of albumin and total protein were not significantly different between the groups. There were more patients with weight loss over 5 kg after surgery in the LTG group than in the TULPG-SEV group (P = 0.043). There was no significant difference in the 3-year overall survival rate between the two groups (P = 0.356).ConclusionSEV has a certain antireflux effect and can reduce the anastomosis time. Proximal gastrectomy may be better than total gastrectomy for maintaining postoperative hemoglobin levels and reducing weight loss.
Highlights
The esophagogastric junction (EGJ) is the area that connects the distal esophagus and the proximal stomach
Proximal gastrectomy may be better than total gastrectomy for maintaining postoperative hemoglobin levels and reducing weight loss
The Siewert (German researcher) classification is the most widely used grading system in the world [3]: Siewert type I refers to adenocarcinoma with the center located 1 to 5 cm above the EGJ, type II refers to adenocarcinoma with the center located between 1 cm above and 2 cm below the EGJ, and type III refers to adenocarcinoma with the center located 2 to 5 cm below the EGJ
Summary
The esophagogastric junction (EGJ) is the area that connects the distal esophagus and the proximal stomach. The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased. This trend was noted in Asia and Europe [1, 2]. A number of studies have shown that upper gastric cancer with tumor diameter less than 4 cm is associated with an extremely low metastasis rate in stations 5 and 6 lymph nodes [8, 9]. This has become the basis for the feasibility of PG. This study was conducted to compare and analyze the short-term efficacy and long-term prognosis of this anastomosis reconstruction method versus laparoscopic total gastrectomy (LTG)
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