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.