Advertisement

Gastric Cancer

, Volume 22, Issue 5, pp 1036–1043 | Cite as

Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer

  • Yoshiaki Shoji
  • Souya NunobeEmail author
  • Satoshi Ida
  • Koshi Kumagai
  • Manabu Ohashi
  • Takeshi Sano
  • Naoki Hiki
Original Article
  • 387 Downloads

Abstract

Background

Double-flap technique (DFT) has received increased attention as an anastomotic procedure preventing reflux esophagitis after laparoscopic proximal gastrectomy (LPG) for upper-third gastric cancer. However, incidence of anastomotic stricture still remains high. This study was a retrospective review aimed to demonstrate details of surgical outcomes and to assess risk factors for anastomotic complications using pre-operative CT image after LPG with DFT (LPG–DFT).

Methods

Patient background data, surgical outcomes, post-operative courses, and complications for patients who underwent LPG–DFT from January 2013 to June 2017 were collected. In addition to the details of short-term outcomes, risk factors for anastomotic stricture and gastroesophageal reflux were analyzed.

Results

The study sample was 147 patients, including 139 patients with upper-third gastric cancer and 8 patients with submucosal tumor of the upper-third stomach. The overall morbidity rate was 12.2% (18/147), and 97.3% (143/147) of the patients achieved R0 resection. Twelve (8.3%) patients required endoscopic balloon dilatation for anastomotic stenosis, and six (4.2%) suffered regurgitation grade ≥ B in the Los Angeles classification. Multivariate analysis revealed that diameter of the esophagus < 18 mm on pre-operative CT image and the presence of short-term complications were found to be independent risk factors for post-operative anastomotic stenosis. No specific risk for gastroesophageal reflux was identified.

Conclusions

The incidence rate of anastomotic complications after LPG–DFT was far lower than that reported after conventional esophagogastrostomy. Alternative anastomotic method may be considered for patients with diameter of the esophagus < 18 mm on pre-operative CT image. Prevention of short-term complications may lessen post-operative stricture.

Keywords

Laparoscopy Gastrectomy Anastomosis Stricture Reflux esophagitis 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Wu H, Rusiecki JA, Zhu K, Potter J, Devesa SS. Stomach carcinoma incidence patterns in the United States by histologic type and anatomic site. Cancer Epidemiol Biomarkers Prev. 2009;18(7):1945–52.CrossRefGoogle Scholar
  2. 2.
    Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, et al. Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg. 2011;98(2):255–60.CrossRefGoogle Scholar
  3. 3.
    Isobe Y, Nashimoto A, Akazawa K, Oda I, Hayashi K, Miyashiro I, et al. Gastric cancer treatment in Japan: 2008 annual report of the JGCA nationwide registry. Gastric Cancer. 2011;14(4):301–16.CrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.CrossRefGoogle Scholar
  5. 5.
    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(3):562–70.CrossRefGoogle Scholar
  6. 6.
    Nomura E, Lee SW, Kawai M, Yamazaki M, Nabeshima K, Nakamura K, et al. Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition. World J Surg Oncol. 2014;12:20.CrossRefGoogle Scholar
  7. 7.
    An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg. 2008;196(4):587–91.CrossRefGoogle Scholar
  8. 8.
    Ronellenfitsch U, Najmeh S, Andalib A, Perera RM, Rousseau MC, Mulder DS, et al. Functional outcomes and quality of life after proximal gastrectomy with esophagogastrostomy using a narrow gastric conduit. Ann Surg Oncol. 2015;22(3):772–9.CrossRefGoogle Scholar
  9. 9.
    Tokunaga M, Ohyama S, Hiki N, Hoshino E, Nunobe S, Fukunaga T, et al. Endoscopic evaluation of reflux esophagitis after proximal gastrectomy: comparison between esophagogastric anastomosis and jejunal interposition. World J Surg. 2008;32(7):1473–7.CrossRefGoogle Scholar
  10. 10.
    Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S, et al. Double-flap technique as an antireflux procedure in esophagogastrostomy after proximal gastrectomy. J Am Coll Surg. 2016;223(2):e7–13.CrossRefGoogle Scholar
  11. 11.
    Muraoka A, Kobayashi M, Kokudo Y. Laparoscopy-assisted proximal gastrectomy with the hinged double flap method. World J Surg. 2016;40(10):2419–24.CrossRefGoogle Scholar
  12. 12.
    Nunobe S, Hayami M, Hiki N. Morphological and functional reconstruction of the esophagogastric junction with a double-flap technique after laparoscopic proximal gastrectomy. Ann Laparosc Endosc Surg. 2017.  https://doi.org/10.21037/ales.2017.02.01.Google Scholar
  13. 13.
    Hayami M, Hiki N, Nunobe S, Mine S, Ohashi M, Kumagai K, et al. Clinical outcomes and evaluation of laparoscopic proximal gastrectomy with double-flap technique for early gastric cancer in the upper third of the stomach. Ann Surg Oncol. 2017;24(6):1635–42.CrossRefGoogle Scholar
  14. 14.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.CrossRefGoogle Scholar
  15. 15.
    Mine S, Nunobe S, Watanabe M. A novel technique of anti-reflux esophagogastrostomy following left thoracoabdominal esophagectomy for carcinoma of the esophagogastric junction. World J Surg. 2015;39(9):2359–61.CrossRefGoogle Scholar
  16. 16.
    Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810–20.CrossRefGoogle Scholar
  17. 17.
    Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol. 2011;29(33):4387–93.CrossRefGoogle Scholar
  18. 18.
    Hiki N, Yamamoto Y, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, et al. Laparoscopic and endoscopic cooperative surgery for gastrointestinal stromal tumor dissection. Surg Endosc. 2008;22(7):1729–35.CrossRefGoogle Scholar
  19. 19.
    Seshimo A, Miyake K, Amano K, Aratake K, Kameoka S. Clinical outcome of esophagogastrostomy after proximal gastrectomy for gastric cancer. Hepatogastroenterology. 2013;60(123):616–9.Google Scholar
  20. 20.
    Uyama I, Sugioka A, Matsui H, Fujita J, Komori Y, Hatakawa Y, et al. Laparoscopic side-to-side esophagogastrostomy using a linear stapler after proximal gastrectomy. Gastric Cancer. 2001;4(2):98–102.CrossRefGoogle Scholar
  21. 21.
    Dewar L, Gelfand G, Finley RJ, Evans K, Inculet R, Nelems B. Factors affecting cervical anastomotic leak and stricture formation following esophagogastrectomy and gastric tube interposition. Am J Surg. 1992;163(5):484–9.CrossRefGoogle Scholar
  22. 22.
    Pierie JP, de Graaf PW, Poen H, van der Tweel I, Obertop H. Incidence and management of benign anastomotic stricture after cervical oesophagogastrostomy. Br J Surg. 1993;80(4):471–4.CrossRefGoogle Scholar
  23. 23.
    Ichikawa D, Komatsu S, Kosuga T, Konishi H, Okamoto K, Shiozaki A, et al. Clinicopathological characteristics of clinical early gastric cancer in the upper-third stomach. World J Gastroenterol. 2015;21(45):12851–6.CrossRefGoogle Scholar
  24. 24.
    Xu J, Cao H, Yang JY, Suh YS, Kong SH, Kim SH, et al. Is preoperative staging enough to guide lymph node dissection in clinically early gastric cancer? Gastric Cancer. 2016;19(2):568–78.CrossRefGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

Personalised recommendations