Lower esophageal sphincter-preserving laparoscopy-assisted proximal gastrectomy in patients with early gastric cancer: a method for the prevention of reflux esophagitis

Abstract

Although laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy for early gastric cancer (EGC) is technically feasible and oncologically safe, it has not been popularized because of the frequent occurrence of reflux esophagitis associated with loss of the lower esophageal sphincter (LES). Herein, we present surgical outcomes in patients with LES-preserving LAPG (LES-p LAPG), which may contribute to protecting against postoperative gastroesophageal reflux or stricture in the treatment of proximal EGC. From November 2009 to May 2010, LES-p LAPG was performed in nine patients with clinical EGC, located at the proximal one-third of the stomach with the upper margin of the tumor 3-4cm from the esophagogastric junction. After the resection of the proximal stomach with D1+β lymph node dissection, gastrogastrostomy was performed using a 25-mm circular stapler through a mini-laparotomy wound at the epigastrium. The median operating time was 137.5min (range 120-180). The median number of retrieved lymph nodes and length of the proximal resection margin were 27 (range 7-49) and 2.4cm (range 0.7-5), respectively. The postoperative complications included one gastrogastrostomy stricture and one case of leakage, which were managed by endoscopic balloon dilation and conservative treatment, respectively. None of the patients suffered from symptoms of reflux esophagitis during the follow-up period (median 15months; range 8-28months). This technique of LES-p LAPG for the treatment of proximal EGC could be a simple, safe, and useful technique to prevent esophageal reflux or stricture. This technique requires prospective validation.