A New Laparoscopic Technique for Proximal Gastrectomy with Gastric Tube Reconstruction and Vagal Preservation for Early Gastric Cancer.
- Author:
Gyu Seok CHO
1
;
Hyung Chul KIM
;
Moon Su LEE
;
Cheol Wan LIM
;
Eung Jin SHIN
;
Chong Woo CHU
;
Young Jin KIM
;
Kil Ho KANG
;
Hyo Won LEE
;
Ok Pyung SONG
Author Information
1. Department of Surgery, University of Soonchunhyang, College of Medicine, Bucheon, Korea. gschogs@schbc.ac.kr
- Publication Type:Original Article
- Keywords:
Laparoscopic gastrectomy;
Proximal gastric cancer
- MeSH:
Abdomen;
Diagnosis;
Gastrectomy*;
Humans;
Incidence;
Length of Stay;
Lymph Node Excision;
Lymph Nodes;
Mass Screening;
Mortality;
Operative Time;
Pneumoperitoneum;
Quality of Life;
Stomach;
Stomach Neoplasms*
- From:Journal of the Korean Surgical Society
2005;69(2):129-134
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: The reported incidence of early gastric cancer located in the upper portion of the stomach has been increasing with the recent advances in its diagnosis and screening. Recently, we have successfully performed laparoscopic assisted proximal gastrectomy and gastric tube reconstruction, without pyloroplasty, on six patients with an early gastric carcinoma located in the upper third of the stomach. Herein, we describe our modification of this procedure. METHODS: After creating a surgical pneumoperitoneum, the stomach was mobilized using laparoscopic coagulating shears. The upper half of the greater curvature and three- quarters of the lesser curvature were then dissected in conjunction with a regional D2 lymphadenectomy. This was followed by a 5 cm, longitudinal mini-laparotomy in the upper abdomen, with the construction of the exterior stomach using a 20 cm long and 4 cm wide gastric tube. Reconstruction, with an esophagogastrostomy, was performed using a circular stapler. RESULTS: No post-operative morbidity or mortality was observed in this small series of patients. The average operative time and blood loss were 230 minutes, ranging from 190~290 minutes, and 150 ml, ranging from 90-180 ml, respectively. The mean number of lymph nodes harvested during these laparoscopic proximal gastrectomies was 22.8 nodes, ranging from 19~30 lymph nodes. The average postoperative hospital stays was 8.3 days, ranging from 7~10 days. CONCLUSION: Our technique of laparoscopic assisted proximal gastrectomy and gastric tube reconstruction, without pyloroplasty, offers a minimally invasive technique, with the potential of improving the post-operative quality of life of patients with early-stage proximal gastric cancer.
