Near-Total Gastrectomy Preserving the Lower Esophageal Sphincter Followed by Jejunal Pouch Interposition as a Treatment for Upper Gastric Cancer.
10.4174/jkss.2010.78.5.290
- Author:
Dong Jin KIM
1
;
Hoon HUR
;
Hae Myung JEON
;
Wook KIM
Author Information
1. Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. kimwook@catholic.ac.kr
- Publication Type:Original Article
- Keywords:
Gastric cancer;
Lower esophageal sphincter;
Jejunal pouch interposition
- MeSH:
Constriction, Pathologic;
Deglutition;
Esophageal Sphincter, Lower;
Gastrectomy;
Gastroesophageal Reflux;
Humans;
Retrospective Studies;
Stomach Neoplasms
- From:Journal of the Korean Surgical Society
2010;78(5):290-297
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Conventional total gastrectomy with Roux-en-Y esophagojejunostomy has certain limitations such as insufficient food reservoir and malabsorption of nutrients. Therefore, we performed reconstruction of the jejunal pouch interposition (JPI) after near-total gastrectomy preserving the lower esophageal sphincter (LES). We compared the technical feasibility, safety, and surgical outcome of this operation with conventional total gastrectomy accompanying with Roux-en-Y esophagojejunostomy. METHODS: From April 2003 to October 2005, 15 LES-preserving, near-total gastrectomies with JPI (LES-JPI group) were performed. The clinical features and surgical outcomes were retrospectively compared with 17 cases of conventional R-Y esophagojejunostomy. Statistical analysis was performed using Fisher's exact test for categorical data and an unpaired t-test for continuous data. RESULTS: Clinicopathological features of the LES-JPI and R-Y groups did not show differences excepting patient age (50.8+/-5.8 years vs. 62.8+/-12.4, respectively; P=0.002) and the depth of tumor invasion (T1-T2; 11~4 vs. 5~12; P=0.032). The operative outcomes for the two groups significantly differed in terms of operation time (676 vs. 484 min; P=0.008) and blood loss (424 vs. 336 ml; P=0.006). Postoperative gastrofiberscopic examination of all LES-JPI patients showed no esophageal reflux or strictures and intact LES. In addition, the LES-JPI group did not experience swallowing difficulty or stricture. CONCLUSION: LES-preserving total gastrectomy with JPI is a feasible and safe procedure for patients with upper gastric cancer.
