Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma.

BACKGROUND: We performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) using functional end-to-end anastomosis (FEEA) as the first choice and laparoscopic-assisted total gastrectomy (LATG) using a circular stapler with a transorally inserted anvil as the second choice. PATIENTS AND METHODS: We examined 109 patients with gastric cancer who underwent TLTG and LATG. Among these, 100 patients underwent TLTG and the rest underwent LATG. RESULTS: The length of resected esophageal segment in LATG patients was significantly longer than that in TLTG patients (P<0.001). The length of the resected esophagus segment was inversely correlated with body mass index in cases of esophagojejunostomy by FEEA (P<0.05). Multivariate analysis revealed that T factor, N factor, and severe complications were the independent factors for survival. CONCLUSIONS: Esophagojejunostomy using FEEA or a circular stapler with a transorally inserted anvil should be selected according to the length of the resected esophageal segment and/or body mass index.

Reconstruction methods and complications in proximal gastrectomy for gastric cancer, and a comparison with total gastrectomy.

Proximal gastrectomy (PG) is a widely accepted, efficient treatment for upper-third early gastric cancer. However, it is associated with reduced quality of life (QOL) following surgery, and cancer recurrence in the remaining stomach. Various reconstruction methods have been proposed, but the optimal method has yet to be determined. We investigated the clinicopathological characteristics, reconstruction methods, and postoperative complications in 101 cases of PG, and additionally compared 93 cases of early gastric cancer treated by PG, and 38 cases treated by total gastrectomy (TG). We found that esophagogastrostomy was superior in terms of operation time, intraoperative blood loss, and postoperative hospital stay, while no significant differences were observed in postoperative complications compared with jejunal interposition or jejunal pouch interposition. We found more cases of multiple gastric cancers and advanced-stage cancer in the TG group than in the PG group. The TG group also had a significantly higher proportion of cases with large tumor diameters, low degrees of differentiation, many lymph node metastases, and advanced-stage disease. There were no differences in the recurrence rate or survival rate between the PG and TG groups. The PG group also showed significantly better results in operating time, intraoperative blood loss, and postoperative complications, with a tendency toward shorter hospital stays. In conclusion, PG is a curative but less invasive treatment for upper-third early gastric cancer, and esophagogastrostomy can be considered the most satisfactory reconstruction method following PG.

Reducing the gastroesophageal reflux with lip-type reinforcement technique during intrathoracic esophagogastrostomy.

BACKGROUND/AIMS: Gastroesophageal reflux is a significant problem after esophagogastrostomy, and impact considerably upon the quality of patients' lives. Aims of this study were to evaluate the operative effects in prevention of reflux with lip-type reinforcement during intrathoracic esophagogastric anastomosis. METHODOLOGY: From January 2005 to December 2009, 216 patients received circular stapled esophagogastrostomy with lip-type reinforcement (LR group), and 69 patients with standard reinforcement (SR group) at our hospital. Major observation parameters were symptoms of reflux and dysphagia. RESULTS: No differences in clinicopathologic characteristics between two groups, in addition to the incidence of anastomotic leakage was less in LR group (p = 0.039). Grade of dysphagia and anastomotic stricture also were not different between two groups (p >0.05). Symptoms of reflux were better controlled in patients with lip-type reinforcement than standard reinforcement (p <0.001). In LR group, 71.3% were asymptomatic with respect to reflux compared to 29.7% in SR group (p <0.001). The incidence of reflux esophagitis was 23.5% in LR group and 58.3% in SR group (p <0.001). There was a significant correlation between reflux symptoms and endoscopic findings of reflux esophagitis (p = 0.001). CONCLUSIONS: Lip-type reinforcement is simple to perform, and effective in controlling gastroesophageal reflux and decreasing anastomotic leakage in majority of patients after esophagogastrostomy.

[Cervical esophago-gastrostomy via the posterior mediastinal route for carcinoma of the thoracic esophagus].

From 1981 to 1990, 297 cases of carcinoma of the thoracic esophagus were resected in our department. Among these cases, 225 cases (84.3%) were reconstructed cervical esophagogastrostomy via the posterior mediastinal route. In this paper, these 225 cases were analysed to evaluate the usefulness of this procedure which was developed by S. Abo in 1975. Operative mortality was 4.4% Anastomotic leakage occurred in 24.4% of the cases, but the majority of the cases were treated successfully without any drainage and 83.3% of the cases could start their diet within one month after operation. The volume of oral intake by the patients after discharge increased satisfactorily (1,500-1,800 kcal/day), but the body weight decreased gradually. So the ambulatory enteral nutritional support was started and proved useful for maintaining their body weight. Alkaline reflux evaluated using 24-hour pH-monitoring system was observed in about half of the cases but the degree of the alkaline shift was not strong. Some complaints (heart burn in 6.3%, regurgitation in 21.9%, feeling of fullness after eating in 40.6%, stenotic sensation in 20.7%) were present but not serious.