Safety and efficacy of laparoscopic proximal gastrectomy with SOFY versus laparoscopic total gastrectomy with Roux-en-Y for treating cT1-2 Siewert II/III adenocarcinoma of the esophagogastric junction: a single-center prospective cohort study.

Abstract

Side overlap with fundoplication by Yamashita (SOFY) is an anti-reflux form of esophagogastrostomy. We compared the safety and efficacy of laparoscopic proximal gastrectomy (PG) with SOFY to that of laparoscopic total gastrectomy (TG) with Roux-en-Y for treating cT1-2 Siewert II/III adenocarcinoma of the esophagogastric junction. Fifty-two patients who underwent PG (n = 28) or TG (n = 24), without conversion to laparotomy, were included. Surgical outcomes, complications, reflux symptoms, quality of life, and nutritional status of both groups were compared. Significant differences between PG and TG groups regarding operative time (245.7 versus 294.6min, P = 0.005), reconstruction time (22.1 versus 28.5min, P < 0.001), time to pass gas (3 versus 4days, P = 0.021), time to oral intake (4.5 versus 5days, P = 0.043), and gastroesophageal reflux (60.7% versus 4.2%, P < 0.001) were observed. Reflux esophagitis for the PG group was 42.9% (12/28). The incidence of Los Angeles grade B and above was 10.7%. Between-group differences in terms of global health status, diarrhea, reflux, and eating were observed. Body weight maintenance was better in the PG group than in the TG group 6months and 1year postoperatively. SOFY is simple and more advantageous than TG in terms of postoperative recovery, body weight, eating, and diarrhea. However, the occurrence of postoperative reflux after SOFY was high. The limitations of this study are the significant differences in pathological T stage of patients in the two groups and the small sample size.