Proximal gastrectomy with gastric tube reconstruction or jejunal interposition reconstruction in upper-third gastric cancer: which offers better short-term surgical outcomes?

Zhiguo Li,Yingwei Xue,Guiting Liu,Yan Ma,Ming Fang

doi:10.1186/s12893-021-01239-7

Abstract

ObjectiveProximal gastrectomy acts as a function-preserving operation for upper-third gastric cancer. The aim of this study was to compare the short-term surgical outcomes between proximal gastrectomy with gastric tube reconstruction and proximal gastrectomy with jejunal interposition reconstruction in upper-third gastric cancer.MethodsA retrospective review of 301 patients who underwent proximal gastrectomy with jejunal interposition (JI) or gastric tube (GT) at Harbin Medical University Cancer Hospital between June 2007 and December 2016 was performed. The Gastrointestinal Symptom Rating Scale (GSRS) and Visick grade were used to evaluate postgastrectomy syndromes. Gastrointestinal fiberoscopy was used to evaluate the prevalence and severity of reflux esophagitis based on the Los Angeles (LA) classification system.ResultsThe JI group had a longer operation time than the GT group (220 ± 52 vs 182 ± 50 min), but no significant difference in blood loss was noted. Compared to the GT group, the Visick grade and GSRS score were significantly higher. Reflux esophagitis was significantly increased in the GT group compared with the JI group.ConclusionProximal gastrectomy is well tolerated with excellent short-term outcomes in patients with upper-third gastric cancer. Compared with GT construction, JI construction has clear functional advantages and may provide better quality of life for patients with upper-third gastric cancer.

Highlights

Gastric cancer is one of most common types of solid tumors and the leading life-threatening cancer [1]
All cases were confirmed by pathological diagnoses through electronic gastroscopies, and we used the 7th edition of the TNM classification to evaluate the pathological staging by the Union for International Cancer Control/American Joint Committee on Cancer (AJCC) [7]
No significant differences in sex, weight, Body Mass Index (BMI), blood loss, tumor size, ABO blood type, TNM stage, Lauren classification, or vessel invasion were noted between the groups

Summary

Introduction

Gastric cancer is one of most common types of solid tumors and the leading life-threatening cancer [1]. In 2018, more than one million new cases of gastric. Proximal gastrectomy (PG) was recommended for the surgical treatment of early gastric cancer in the 2018 Japanese Gastric Cancer Guidelines [3]. The standard procedure for advanced gastric cancer of the upper stomach should be total gastrectomy, it was reported that distant side lymph node metastasis was rare if the tumor was localized to the upper stomach [4]. Proximal gastrectomy was chosen for favorable prognosis with reduced postgastrectomy symptoms and surgical invasiveness [5, 6]. A general consensus on the choice of surgical method for upper-third gastric cancer is lacking

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Discussion

Conclusion