Preliminary efficacy analysis of Cheng's Giraffe reconstruction after proximal gastrectomy in adenocarcinoma of esophagogastric junction
10.3760/cma.j.issn.1671-0274.2020.02.011
- VernacularTitle: 食管-胃"程氏Giraffe重建术"在食管胃结合部腺癌近端胃切除后消化道重建患者中应用的初步疗效分析
- Author:
Xiangdong CHENG
1
;
Zhiyuan XU
1
;
Yi′an DU
1
;
Can HU
1
;
Jianfa YU
2
;
Litao YANG
1
;
Ling HUANG
1
;
Pengfei YU
1
;
Gaiguo DAI
1
;
Yanqiang ZHANG
1
Author Information
1. Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
2. Department of Gastrointestinal Surgery, The First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310006, China
- Publication Type:Journal Article
- Keywords:
Esophageogastric junction adenocarcinoma;
Cheng'
s giraffe reconstruction;
Gastrectomy, proximal;
Gastroesophageal reflux
- From:
Chinese Journal of Gastrointestinal Surgery
2020;23(2):158-162
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety and feasibility of proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction for the treatment of early Siewert II adenocarcinoma of esophagogastric junction (AEG).
Methods:Indication of Cheng's Giraffe esophagogastric reconstruction: (1) Siewert II AEG or Siewert III AEG with diameter < 4 cm; (2) preoperative staging as cT1-2N0M0. A descriptive case series study was carried out. Clinical data of 34 patients with Siewert II AEG undergoing proximal partial gastrectomy and Cheng's Giraffe esophagogastric reconstruction at Department of Abdominal Surgery of Zhejiang Cancer Hospital and Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from February to July 2018 were retrospectively collected and analyzed, including 14 cases in IA stage, 11 cases in IIA stage and 8 cases in IIB stage. Brief procedure of Cheng's Giraffe esophagogastric reconstruction was as follows: Firstly, 12 cm long tubular stomach was formed by longitudinal incision 4 cm away from the great curvature of the stomach. Secondly, the gastric fundus and His angle were formed. Finally, the distance from His angle to esophagal-tubular gastric anastomosis should be more than 5 cm. The reflux disease questionare (RDQ) scores, radionuclide gastric emptying scintigraphy, and 24-hour multichannel intraluminal (MII)-pH monitoring technology were used to evaluate postoperative gastric emptying and gastroesophageal reflux.
Result:All 34 patients successfully completed proximal partial gastrectomy with Cheng's Giraffe esophagogastric reconstruction, including 13 cases by open surgery and 21 cases by laparoscopic surgery. The operation time was (144.6±39.8) minutes, the blood loss during operation was (35.4±17.2) ml. No laparoscopic case was converted to open surgery and no postoperative complication was observed. The postoperative hospital stay was (8.4±2.5) days. The postoperative RDQ score was 4.4±3.1 one month after operation, and 3.3±2.5 six months after operation. Gastric-half emptying time was (67.0±21.5) minutes, and the residual ratio was (52.2±7.7)% in 1 hour, (36.4±3.1)% in 2 hours and (28.8±3.6)% in 3 hours at postoperative 1-month. The 24-hour MII-pH monitoring at postoperative 2-month revealed the frequency of acid reflux was (12.6±7.9) times, frequency of non-acid reflux was (19.6±9.7) times, DeMeester score was 5.8±2.9.
Conclusion:Cheng's Giraffe esophagogastric reconstruction is safe and feasible in the treatment of Siewert type II AEG, and has good dynamic and anti-reflux effects.
