Comparison of efficacy between laparoscopic and open proximal gastrectomy with double-tract reconstruction for Siewert type Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction / 中华胃肠外科杂志

Objective: To compare the efficacy between laparoscopic and open proximal gastrectomy with double-tract reconstruction for Siewert type II and III adenocarcinoma of the esophagogastric junction (AEG). Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) 18 to 80 years old; (2) Siewert II and III AEG was confirmed by preoperative gastroscopy and biopsy, which could not be resected by endoscopy; patients undergoing radical proximal gastrectomy with double-tract reconstruction; (3) contrast-enhanced abdominal CT staging was cT1-2N0M0; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, American Association of Anesthesiologists (ASA) grade 1 to 2; (5) patients agreed to perform proximal gastrectomy and signed an informed consent. Those who had undergone neoadjuvant radiochemotherapy, suffered from serious mental diseases and had incomplete data were excluded. According to the above criteria, clinical data of 84 consecutive patients with Siewert II and III AEG undergoing surgery at General Surgery Department of The Affiliated Tumor Hospital of Zhengzhou University from October 2010 to December 2018 were collected and analyzed. Of 84 patients, 61 underwent open proximal gastrectomy with double-tract reconstruction (OPG group), while 23 underwent laparoscopic proximal gastrectomy with double-tract reconstruction (LPG group). The perioperative complications and postoperative reflux esophagitis of two groups were compared. A P-value of <0.05 was considered to be statistically significant. Results: Among 84 cases, 74 were male and 10 were female. There were 43 cases of Siewert type II and 41 cases of Siewert type III. There were no significant differences in age, gender, body mass index, comorbidities, Siewert type, and tumor staging between the two groups (all P>0.05). As compared to the OPG group, the LPG group had longer operation duration [(223±21) minutes vs. (161±14) minutes, t=15.352, P<0.001], less intraoperative blood loss [195 (150, 215) ml vs. 208 (192, 230) ml, Z=2.143, P=0.032], and shorter time to flatus [(2.8±0.7) days vs. (3.3±0.9) days, t=2.477, P=0.015]. There were no significant differences in the number of harvested lymph nodes, time to the first meal and postoperative hospital stay between the two groups (all P>0.05). Postoperative complications developed in 2 cases (8.7%, 1 case each for anastomotic leakage and intestinal obstruction) in the LPG group and 5 cases (8.2%, 1 case each for anastomotic leakage, anastomotic bleeding, and anastomotic stenosis, 2 cases of incision infection) in the OPG group (χ(2)=5.603, P=0.231). The median follow-up was 41.2 (12.8-110.5) months. One patient (1.6%,1/61) had obvious reflux symptoms in the OPG group, compared with none in the LPG group (χ(2)=0.644, P=0.422). Esophagitis occurred in 1 case (4.8%, 1/21) in LPG group, compared with 4 patients (7.1%, 4/56) in the OPG group, without significant difference between the two groups (χ(2)=0.505, P=0.477). Conclusion: Laparoscopic proximal gastrectomy with double-tract reconstruction is safe and feasible without increasing the risk of postoperative complication and reflux esophagitis.

Application of jejunal interposition after radical proximal gastrectomy / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore an ideal method of digestive tract reconstruction and tolerance to adjuvant chemotherapy after radical proximal gastrectomy.</p><p><b>METHODS</b>Thirty patients in the reconstruction group were treated by jejunal interposition, and other 30 patients received gastroesophagostomy (control group). The operation time, operation risk, occurrence of reflux esophagitis and postoperative 1-, 3-, 6-month nutrition statuses were evaluated. Forty-three patients received postoperative adjuvant chemotherapy with mFOLFOX-6 and tolerance to the chemotherapy was assessed.</p><p><b>RESULTS</b>The operation time of the reconstructional group was (162.2 ± 14.0)min and that of the control group was (137.6 ± 18.9)mi, with a statistically significant difference. (t = -5.7, P<0.01). There were no significant differences of operation risk, postoperative 2-, 4-, and 6-day C-reactive protein, 2-, 4- and 6-day systemic inflammatory response syndrome between the two groups. The differences of the occurrence of postoperative 1-, 3- and 6-month reflux esophagitis and 3- and 6-month nutritional status between the two groups were statistically significant. 18 of 19 (94.7%) patients in the reconstruction group completed all six cycles of chemotherapy, 24 patients in the control group received chemotherapy, and 12 (50.0%) of them completed 6 cycles of chemotherapy. There was a significant difference in the completion rate of chemotherapy of the two groups (P<0.05).</p><p><b>CONCLUSIONS</b>The postoperative complications of jejunal interposition are not inceased, the symptoms of reflux esophagitis are alleviated, the quality of life can be improved, and there is a better tolerance to adjuvant chemotherapy. Therefore, jejunal interposition after radical proximal gastrectomy is a rational method of digestive tract reconstruction.</p>