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11.01.2017 | Ausgabe 9/2017

Surgical Endoscopy 9/2017

Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life

Zeitschrift:
Surgical Endoscopy > Ausgabe 9/2017
Autoren:
Tatsuto Nishigori, Hiroshi Okabe, Shigeru Tsunoda, Hisashi Shinohara, Kazutaka Obama, Hisahiro Hosogi, Shigeo Hisamori, Kikuko Miyazaki, Takeo Nakayama, Yoshiharu Sakai
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s00464-016-5403-y) contains supplementary material, which is available to authorized users.

Abstract

Background

Proximal gastrectomy is not widely performed because the procedure is complicated, particularly under laparoscopy. We developed a simple laparoscopic technique of hand-sewn esophagogastrostomy with an anti-reflux mechanism. This study aimed to evaluate and compare the postoperative body weight loss (BWL) and quality of life (QOL) following laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) in patients with upper gastric cancer.

Methods

We retrospectively analyzed patients with stage I upper gastric cancer undergoing LPG or LTG at Kyoto University Hospital between March 2006 and June 2014. The main outcome measures were the % BWL 1 year after gastrectomy, postoperative anastomotic stricture, and reflux esophagitis. Additionally, patient-reported outcomes were evaluated using the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45 in patients presenting at the outpatient clinic and exhibiting no recurrence.

Results

A total of 62 patients were included in this study (LTG, n = 42 vs. LPG, n = 20). The % BWL at 12 months in the LPG group was less than that in the LTG group (−16.3 vs. −10.7%). Multivariate analysis revealed that LPG was associated with less BWL (P = 0.003). Anastomotic stricture occurred more frequently in the LPG group than in the LTG group (0 vs. 25%). One patient in each group exhibited grade B severity of reflux esophagitis (based on the Los Angeles classification). In the questionnaire survey, LPG was better than LTG in terms of diarrhea and dissatisfaction with symptoms. In terms of reflux symptoms, patients in the LPG group experienced less acid and bile regurgitation symptoms compared with those in the LTG group.

Conclusions

LPG with hand-sewn esophagogastrostomy results in less postoperative BWL and better QOL than LTG despite higher rates of anastomotic stricture.

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Zusatzmaterial
Supplemental Figure. Overall survival of patients in both groups. There were no significant differences in the overall survival rates between the groups (P = 0.90). LTG, laparoscopic total gastrectomy; LPG, laparoscopic proximal gastrectomy. (TIFF 26 kb)
464_2016_5403_MOESM1_ESM.tif
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