Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014

Proximal gastrectomy (PG) is occasionally performed to preserve the physiological function of the remnant stomach with the aim of maintaining a gastric reservoir for patients with early gastric cancer in the upper third of the stomach. Many reconstructive procedures after PG have been reported, incl...

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Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2016-05, Vol.46 (5), p.517-527
Main Authors: Nakamura, Masaki, Yamaue, Hiroki
Format: Article
Language:English
Subjects:
Esophagitis, Peptic - epidemiology
Esophagitis, Peptic - prevention & control
Gastrectomy - methods
Gastrostomy - methods
Humans
Jejunum - surgery
Laparoscopy
Medicine
Medicine & Public Health
Organ Sparing Treatments - methods
Postoperative Complications - epidemiology
Postoperative Complications - prevention & control
Quality of Life
Reconstructive Surgical Procedures
Review Article
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgery
Surgical Oncology
Treatment Outcome
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Summary:Proximal gastrectomy (PG) is occasionally performed to preserve the physiological function of the remnant stomach with the aim of maintaining a gastric reservoir for patients with early gastric cancer in the upper third of the stomach. Many reconstructive procedures after PG have been reported, including esophagogastrostomy (EG), jejunal interposition, jejunal pouch interposition, and double tract. However, no general agreement exists regarding the optimal reconstructive procedure. This article reviews the current reconstructive procedures available for PG. We examined the surgical outcomes, postoperative complications, endoscopic findings, and quality of life (QOL) according to the reconstructive procedures. We found no significant difference in anastomotic leakage and anastomotic stricture among the procedures. The frequency of reflux esophagitis was higher with simple EG compared with the other reconstructive procedures. Some additional procedures, such as fundoplication, the use of a narrow gastric conduit, and placement of a gastric tube in the lower mediastinum on EG, could decrease the frequency of reflux esophagitis and reflux symptoms. These additional procedures may improve the QOL; however, the previous studies were small and could not adequately compare the reconstructive procedures. Prospective randomized controlled trials that involve a longer trial period and more institutions are needed to clarify the optimal reconstructive procedures after PG.
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-015-1185-4