Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
A modified gastric tube reconstruction after laparoscopic proximal gastrectomy for early adenocarcinoma in the upper third stomach and esophagogastric junction: short-term surgical outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Liao Yi, Tam Wengcheong, Chen Hao, Huang Jintuan, Xiang Jun, Chen Chunyu, Yang Zuli
Аннотация
BACKGROUND: Proximal gastrectomy with conventional esophagogastrostomy is frequently associated with postoperative complications, including significant reflux esophagitis. This study aimed to evaluate a modified reconstruction technique that combines gastric tube (GT) formation with overlap anastomosis and partial fundoplication.
METHODS: Between January 2021 and January 2024, 29 consecutive patients diagnosed with early-stage proximal gastric cancer underwent laparoscopic proximal gastrectomy using our novel reconstruction method. The surgical protocol included the creation of a GT conduit, overlap esophagogastric anastomosis, and partial fundoplication procedure. Perioperative outcomes and postoperative follow-up data were prospectively collected.
RESULTS: The cohort demonstrated a mean operative time of 239 ± (SD) 50 min and a median estimated blood loss of 50 mL (IQR, 20-150). Lymph node dissection yielded a median count of 25 nodes (IQR, 9-66). Postoperative complications included 1 case (3.4%) of anastomotic leakage requiring conservative management. Mild reflux symptoms (heartburn) were transiently observed in 2 patients (6.9%), both resolving with short-term proton pump inhibitor therapy. Endoscopic evaluation at the 3-month follow-up revealed grade A or B reflux esophagitis (Los Angeles classification) in 2 patients (6.9%). Nutritional parameters (serum albumin and total protein levels) showed expected postoperative declines during the initial 3-month period, followed by progressive recovery to preoperative baseline values by 6 months postoperatively (P <.05 for longitudinal comparison).
CONCLUSION: Our preliminary findings suggest that GT reconstruction with overlap anastomosis and partial fundoplication is a technically feasible and safe approach for proximal gastrectomy, demonstrating acceptable short-term functional outcomes with mitigated reflux complications.
METHODS: Between January 2021 and January 2024, 29 consecutive patients diagnosed with early-stage proximal gastric cancer underwent laparoscopic proximal gastrectomy using our novel reconstruction method. The surgical protocol included the creation of a GT conduit, overlap esophagogastric anastomosis, and partial fundoplication procedure. Perioperative outcomes and postoperative follow-up data were prospectively collected.
RESULTS: The cohort demonstrated a mean operative time of 239 ± (SD) 50 min and a median estimated blood loss of 50 mL (IQR, 20-150). Lymph node dissection yielded a median count of 25 nodes (IQR, 9-66). Postoperative complications included 1 case (3.4%) of anastomotic leakage requiring conservative management. Mild reflux symptoms (heartburn) were transiently observed in 2 patients (6.9%), both resolving with short-term proton pump inhibitor therapy. Endoscopic evaluation at the 3-month follow-up revealed grade A or B reflux esophagitis (Los Angeles classification) in 2 patients (6.9%). Nutritional parameters (serum albumin and total protein levels) showed expected postoperative declines during the initial 3-month period, followed by progressive recovery to preoperative baseline values by 6 months postoperatively (P <.05 for longitudinal comparison).
CONCLUSION: Our preliminary findings suggest that GT reconstruction with overlap anastomosis and partial fundoplication is a technically feasible and safe approach for proximal gastrectomy, demonstrating acceptable short-term functional outcomes with mitigated reflux complications.