Skip to main content

Advertisement

SpringerLink
Log in

A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study

  • original article
  • Published:
European Surgery Aims and scope Submit manuscript

Summary

Background

Total gastrectomy has been performed for adenocarcinoma of the esophagogastric junction (AEG) because of severe gastro-esophageal reflux (GER) after classic esophago-gastrostomy. Thus, we applied a novel esophago-gastrostomy with anti-reflux triangle-valve (EGAT) in Siewert type II/III AEG patients to prevent postoperative GER.

Methods

This was a three-year retrospective cohort study. We followed 144 Siewert type II/III AEG patients who underwent EGAT (n = 73) and total gastrectomy (TG, n = 71) at our hospital. We analyzed the incidence of postoperative nutritional (hemoglobin, protein levels, and weight) and reflux esophagitis in the two groups. Finally, we conducted a survival analysis was performed.

Results

The average operation time was significantly lower in the EGAT group than in the TG group. However, no significant differences were detected for postoperative complications between the two groups. Postoperative nutritional indexes, including albumin and prealbumin, were significantly higher in the EGAT group than in the TG group six months after surgery. Moreover, we evaluated the hemoglobin one year after surgery, and total protein and body weight after two years of surgery were significantly higher in the EGAT group compared to the TG group. Further, the reflux esophagitis follow-up did not differ (p > 0.05). Finally, no significant difference was detected in the 3‑year overall survival rate between the two groups of patients (p = 0.519).

Conclusion

EGAT is simple and can prevent GER in Siewert type II/III AEG patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Wang S, Chen Y, Zhang H, Liang Z, Bu J. The value of predicting human epidermal growth factor receptor 2 status in adenocarcinoma of the esophagogastric junction on CT-based radiomics nomogram. Front Oncol. 2021;11:707686. https://doi.org/10.3389/fonc.2021.707686.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Reid BJ, Li X, Galipeau PC, Vaughan TL. Barrett’s oesophagus and oesophageal adenocarcinoma: time for a new synthesis. Nat Rev Cancer. 2010;10:87–101. https://doi.org/10.1038/nrc2773.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Cheng J, Xie Z, Wang S, Wen S, Niu S, Shi C, Yu L, Xu X. Cough hypersensitivity in patients with metabolic syndrome: a clinical finding and its possible mechanisms. BMC Pulm Med. 2021;21:284. https://doi.org/10.1186/s12890-021-01652-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Wang B, Wu Y, Wang H, Zhang H, Wang L, Zhang Z. Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction. BMC Surg. 2020;20:230. https://doi.org/10.1186/s12893-020-00894-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Gong CS, Kim BS, Kim HS. Comparison of totally laparoscopic total gastrectomy using an endoscopic linear stapler with laparoscopic-assisted total gastrectomy using a circular stapler in patients with gastric cancer: a single-center experience. World J Gastroenterol. 2017;23:8553–61. https://doi.org/10.3748/wjg.v23.i48.8553.

    Article  PubMed  PubMed Central  Google Scholar 

  6. von Rahden BH, Kircher S, Lazariotou M, Reiber C, Stuermer L, Otto C, Germer CT, Grimm M. LgR5 expression and cancer stem cell hypothesis: clue to define the true origin of esophageal adenocarcinomas with and without Barrett’s esophagus? J Exp Clin Cancer Res. 2011;30:23. https://doi.org/10.1186/1756-9966-30-23.

    Article  Google Scholar 

  7. Yamashita H, Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T. Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg. 2011;254:274–80. https://doi.org/10.1097/SLA.0b013e3182263911.

    Article  PubMed  Google Scholar 

  8. Liu BW, Liu Y, Liu JR, Feng ZX. Comparison of hand-sewn and stapled anastomoses in surgeries of gastrointestinal tumors based on clinical practice of China. World J Surg Oncol. 2014;12:292. https://doi.org/10.1186/1477-7819-12-292.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yang C, Shi Y, Xie S, Chen J, Zhao Y, Qian F, Hao Y, Tang B, Yu P. Short-term outcomes of robotic- versus laparoscopic-assisted total gastrectomy for advanced gastric cancer: a propensity score matching study. BMC Cancer. 2020;20:669. https://doi.org/10.1186/s12885-020-07160-1.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zheng Z, Liu X, Xin C, Zhang W, Gao Y, Zeng N, Li M, Cai J, Meng F, Liu D, Zhang J, Yin J, Zhang J, Zhang Z. A new technique for treating hiatal hernia with gastroesophageal reflux disease: the laparoscopic total left-side surgical approach. BMC Surg. 2021;21:361. https://doi.org/10.1186/s12893-021-01356-3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ota K, Takeuchi T, Kojima Y, Sugawara N, Nishida S, Iwatsubo T, Kawaguchi S, Harada S, Tokioka S, Higuchi K. Outcomes of endoscopic submucosal dissection for gastroesophageal reflux disease (ESD-G) for medication-refractory gastroesophageal reflux disease: 35 cases underwent ESD‑G including 15 cases followed more than 5 years. BMC Gastroenterol. 2021;21:432. https://doi.org/10.1186/s12876-021-02022-x.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cho JH. Reflux following esophagectomy for esophageal cancer. Korean J Thorac Cardiovasc Surg. 2020;53:217–21. https://doi.org/10.5090/kjtcs.2020.53.4.217.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Huh YJ, Lee HJ, Oh SY, Lee KG, Yang JY, Ahn HS, Suh YS, Kong SH, Lee KU, Yang HK. Clinical outcome of modified laparoscopy-assisted proximal gastrectomy compared to conventional proximal gastrectomy or total gastrectomy for upper-third early gastric cancer with special references to postoperative reflux esophagitis. J Gastric Cancer. 2015;15:191–200. https://doi.org/10.5230/jgc.2015.15.3.191.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Khalayleh H, Kim YW, Man Yoon H, Ryu KW, Kook MC. Evaluation of lymph node metastasis among adults with gastric adenocarcinoma managed with total gastrectomy. JAMA Netw Open. 2021;4:e2035810. https://doi.org/10.1001/jamanetworkopen.2020.35810.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Li Z, Dong J, Huang Q, Zhang W, Tao K. Comparison of three digestive tract reconstruction methods for the treatment of Siewert II and III adenocarcinoma of esophagogastric junction: a prospective, randomized controlled study. World J Surg Oncol. 2019;17:209. https://doi.org/10.1186/s12957-019-1762-x.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ri M, Kumagai K, Namikawa K, Atsumi S, Hayami M, Makuuchi R, Ida S, Ohashi M, Sano T, Nunobe S. Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? Ann Gastroenterol Surg. 2021;5:767–75. https://doi.org/10.1002/ags3.12486.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Saze Z, Kase K, Nakano H, Yamauchi N, Kaneta A, Watanabe Y, Hanayama H, Hayase S, Momma T, Kono K. Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer. BMC Surg. 2021;21:392. https://doi.org/10.1186/s12893-021-01390-1.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gao Y, Sun J, Chen Y, Zhang Y, Chen P, Zong L, Huang J, Han J, Chen X. Proximal gastrectomy with anti-reflux anastomosis for patients with adenocarcinoma of the esophagogastric junction: the simple and safe triangle-valve technique. Mol Clin Oncol. 2020;13:62. https://doi.org/10.3892/mco.2020.2132.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23. https://doi.org/10.1007/s10120-011-0042-4.

    Article  Google Scholar 

  20. In H, Solsky I, Palis B, Langdon-Embry M, Ajani J, Sano T. Validation of the 8th edition of the AJCC TNM staging system for gastric cancer using the national cancer database. Ann Surg Oncol. 2017;24:3683–91. https://doi.org/10.1245/s10434-017-6078-x.

    Article  PubMed  Google Scholar 

  21. Shaw M, Dent J, Beebe T, Junghard O, Wiklund I, Lind T, Johnsson F. The reflux disease questionnaire: a measure for assessment of treatment response in clinical trials. Health Qual Life Outcomes. 2008;6:31. https://doi.org/10.1186/1477-7525-6-31.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80. https://doi.org/10.1136/gut.45.2.172.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Trung LV, Loc NVV, Tien TPD, Vuong NL. Laparoscopic proximal gastrectomy with jejunal interposition for early proximal gastric cancer. J Gastrointest Cancer. 2021;52:536–41. https://doi.org/10.1007/s12029-020-00420-0.

    Article  PubMed  Google Scholar 

  24. Ji X, Jin C, Ji K, Zhang J, Wu X, Jia Z, Bu Z, Ji J. Double tract reconstruction reduces reflux esophagitis and improves quality of life after radical proximal gastrectomy for patients with upper gastric or esophagogastric adenocarcinoma. Cancer Res Treat. 2021;53:784–94. https://doi.org/10.4143/crt.2020.1064.

    Article  PubMed  Google Scholar 

  25. Shoji Y, Nunobe S, Ida S, Kumagai K, Ohashi M, Sano T, Hiki N. Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer. Gastric Cancer. 2019;22:1036–43. https://doi.org/10.1007/s10120-019-00940-0.

    Article  PubMed  Google Scholar 

  26. Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer. 2014;17:562–70. https://doi.org/10.1007/s10120-013-0303-5.

    Article  PubMed  Google Scholar 

  27. Hosoda K, Washio M, Mieno H, Moriya H, Ema A, Ushiku H, Watanabe M, Yamashita K. Comparison of double-flap and OrVil techniques of laparoscopy-assisted proximal gastrectomy in preventing gastroesophageal reflux: a retrospective cohort study. Langenbecks Arch Surg. 2019;404:81–91. https://doi.org/10.1007/s00423-018-1743-5.

    Article  PubMed  Google Scholar 

  28. Omori T, Yamamoto K, Yanagimoto Y, Shinno N, Sugimura K, Takahashi H, Yasui M, Wada H, Miyata H, Ohue M, Yano M, Sakon M. A novel valvuloplastic esophagogastrostomy technique for laparoscopic transhiatal lower esophagectomy and proximal gastrectomy for Siewert type II esophagogastric junction carcinoma-the tri double-flap hybrid method. J Gastrointest Surg. 2021;25:16–27. https://doi.org/10.1007/s11605-020-04547-0.

    Article  PubMed  Google Scholar 

  29. Wang L, Xia Y, Jiang T, Li F, Wang W, Zhang D, Xu H, Yang L, Xu Z. Short-term surgical outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy for adenocarcinoma of esophagogastric junction: a matched-cohort study. J Surg Res. 2020;246:292–9. https://doi.org/10.1016/j.jss.2019.09.022.

    Article  CAS  PubMed  Google Scholar 

  30. Yamashita Y, Yamamoto A, Tamamori Y, Yoshii M, Nishiguchi Y. Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy. Gastric Cancer. 2017;20:728–35. https://doi.org/10.1007/s10120-016-0674-5.

    Article  PubMed  Google Scholar 

  31. Hosogi H, Sakaguchi M, Yagi D, Onishi R, Hashimoto Y, Sakai Y, Kanaya S. Side-overlap esophagogastric tube (SO-EG) reconstruction after minimally invasive Ivor Lewis esophagectomy or laparoscopic proximal gastrectomy for cancer of the esophagogastric junction. Langenbecks Arch Surg. 2021; https://doi.org/10.1007/s00423-021-02377-5.

    Article  PubMed  Google Scholar 

  32. Zhang H, Sun Z, Xu HM, Shan JX, Wang SB, Chen JQ. Improved quality of life in patients with gastric cancer after esophagogastrostomy reconstruction. World J Gastroenterol. 2009;15:3183–90. https://doi.org/10.3748/wjg.15.3183.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shiraishi N, Hirose R, Morimoto A, Kawano K, Adachi Y, Kitano S. Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy. Gastric Cancer. 1998;1:78–9. https://doi.org/10.1007/s101209800023.

    Article  PubMed  Google Scholar 

  34. Takiguchi S, Hiura Y, Miyazaki Y, Takata A, Murakami K, Doki Y. Clinical trial of ghrelin synthesis administration for upper GI surgery. Methods Enzymol. 2012;514:409–31. https://doi.org/10.1016/B978-0-12-381272-8.00026-X.

    Article  CAS  PubMed  Google Scholar 

  35. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K. Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature. 1999;402:656–60. https://doi.org/10.1038/45230.

    Article  CAS  PubMed  Google Scholar 

  36. Lim CH, Kim SW, Kim WC, Kim JS, Cho YK, Park JM, Lee IS, Choi MG, Song KY, Jeon HM, Park CH. Anemia after gastrectomy for early gastric cancer: long-term follow-up observational study. World J Gastroenterol. 2012;18:6114–9. https://doi.org/10.3748/wjg.v18.i42.6114.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, 450052, Zhengzhou, Henan, China

    Yongshun Gao, Jiangang Sun & Peng Chen

Authors
  1. Yongshun Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jiangang Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yongshun Gao.

Ethics declarations

Conflict of interest

Y. Gao, J. Sun and P. Chen declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

■

■

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gao, Y., Sun, J. & Chen, P. A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study. Eur Surg 55, 124–133 (2023). https://doi.org/10.1007/s10353-023-00806-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-023-00806-x

Keywords

Search

Navigation