Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double t
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition Eiji Nomura1*, Sang-Woong Lee2, Masaru Kawai2, Masashi Yamazaki1, Kazuhito Nabeshima3, Kenji Nakamura3 and Kazuhisa Uchiyama2
Abstract Background: For early gastric cancer located in the upper third of the stomach, we have adopted laparoscopic 1/2-proximal gastrectomy (PG) with two types of reconstruction: double tract reconstruction (L-DT) and jejunal interposition reconstruction with crimping of the jejunum on the anal side of the jejunogastrostomy with a knifeless linear stapler (L-JIP). Methods: Functional outcomes were prospectively compared between these two types of reconstruction following laparoscopic PG. Resection and reconstruction were performed using L-DT (n = 10) and L-JIP (n = 10) alternately. Quality of life was evaluated through a questionnaire and endoscopic examination of the ten patients in each group, and functional evaluations were carried out in five patients of each group. Results: The postoperative/preoperative body weight ratio was significantly higher in the L-JIP group than in the L-DT group. While the incidence of reflux esophagitis was 10% in both groups, the endoscope could reach the remnant stomach in all patients. In the L-DT group, the plasma acetaminophen concentration at 15 minutes and the insulin level at 30 minutes were markedly increased after oral administration, while the increases in the blood sugar level at 30 and 60 minutes were more gradual than in the L-JIP group. Conclusions: While L-JIP may be thought of as the ideal method for function-preserving gastrectomy, L-DT may be suitable for gastric cancer patients with impaired glucose tolerance. These results raise the possibility of individualized selection of reconstruction for gastric cancer patients with various kinds of preoperative complications. Keywords: Gastric cancer, Laparoscopic proximal gastrectomy, Double tract reconstruction, Jejunal interposition reconstruction, Quality of life
Background The incidence of early gastric cancer has increased in recent years [1]. Since patients are expected to survive for longer after surgery, there has been increasing demand for less invasive and safer operative procedures that are associated with improved postoperative quality of life (QOL) [2]. For early primary gastric cancer located in the upper third of the stomach, we perform proximal gastrectomy * Correspondence: [email protected] 1 Department of Gastroenterological and General Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan Full list of author information is available at the end of the article
(PG). Various methods of open or laparoscopic resection with reconstruction have been devised over time [3-5]. Standard PG for early cancer, as defined by the Japanese gastric cancer treatment guidelines [6], requires resection of less than half of the
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