Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

  • Huh, Yeon-Ju (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Hyuk-Joon (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Oh, Seung-Young (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Kyung-Goo (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yang, Jun-Young (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Ahn, Hye-Seong (Department of Surgery, Seoul National University Boramae Medical Center) ;
  • Suh, Yun-Suhk (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kong, Seong-Ho (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Lee, Kuhn-Uk (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Yang, Han-Kwang (Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • Received : 2015.07.02
  • Accepted : 2015.09.14
  • Published : 2015.09.30
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Abstract

Purpose: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.

Keywords

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