Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer.
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical
/ methods
Female
Follow-Up Studies
Gastrectomy
/ methods
Humans
Laparoscopy
/ methods
Length of Stay
/ statistics & numerical data
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Risk Assessment
/ methods
Stomach Neoplasms
/ pathology
Treatment Outcome
Anastomosis
Gastrectomy
Laparoscopy
Reflux esophagitis
Stricture
Journal
Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association
ISSN: 1436-3305
Titre abrégé: Gastric Cancer
Pays: Japan
ID NLM: 100886238
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
14
12
2018
accepted:
10
02
2019
pubmed:
7
3
2019
medline:
11
2
2020
entrez:
7
3
2019
Statut:
ppublish
Résumé
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). 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 30838469
doi: 10.1007/s10120-019-00940-0
pii: 10.1007/s10120-019-00940-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1036-1043Références
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.
doi: 10.1158/1055-9965.EPI-09-0250
pubmed: 19531677
pmcid: 2786772
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.
doi: 10.1002/bjs.7310
pubmed: 21082693
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.
doi: 10.1007/s10120-011-0085-6
pubmed: 21894577
pmcid: 3196643
Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.
doi: 10.1007/s10120-016-0622-4
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.
doi: 10.1007/s10120-013-0303-5
pubmed: 24052482
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.
doi: 10.1186/1477-7819-12-20
pubmed: 24468278
pmcid: 3909373
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.
doi: 10.1016/j.amjsurg.2007.09.040
pubmed: 18519129
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.
doi: 10.1245/s10434-014-4078-7
pubmed: 25212836
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.
doi: 10.1007/s00268-007-9459-7
pubmed: 18264827
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.
doi: 10.1016/j.jamcollsurg.2016.04.041
pubmed: 27157920
Muraoka A, Kobayashi M, Kokudo Y. Laparoscopy-assisted proximal gastrectomy with the hinged double flap method. World J Surg. 2016;40(10):2419–24.
doi: 10.1007/s00268-016-3510-5
pubmed: 27094564
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 .
doi: 10.21037/ales.2017.02.01
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.
doi: 10.1245/s10434-017-5782-x
pubmed: 28130623
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101–12.
doi: 10.1007/s10120-011-0041-5
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.
doi: 10.1007/s00268-015-3079-4
pubmed: 25902729
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.
doi: 10.1056/NEJMoa072252
pubmed: 17978289
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.
doi: 10.1200/JCO.2011.36.5908
pubmed: 22010012
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.
doi: 10.1007/s00464-007-9696-8
pubmed: 18074180
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.
pubmed: 23108089
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.
doi: 10.1007/PL00011731
pubmed: 11706768
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.
doi: 10.1016/0002-9610(92)90393-6
pubmed: 1575303
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.
doi: 10.1002/bjs.1800800422
pubmed: 8495314
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.
doi: 10.3748/wjg.v21.i45.12851
pubmed: 26668509
pmcid: 4671040
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.
doi: 10.1007/s10120-015-0512-1
pubmed: 26231352