Initial Results of Laparoscopic Proximal Gastrectomy With Double-tract Reconstruction Using Oblique Jejunogastrostomy Method on the Long-term Outcome of Postoperative Nutritional Status: A Propensity Score-matched Study

Keigo Kimura1, Yuma Ebihara1,2, Kimitaka Tanaka1, Yoshitsugu Nakanishi1, Toshimichi Asano1, Takehiro Noji1, Yo Kurashima1, Soichi Murakami1, Toru Nakamura1, Takahiro Tsuchikawa1, Keisuke Okamura1, Toshiaki Shichinohe1, Satoshi Hirano1
1Department of Gastroenterological Surgery II, Faculty of Medicine
2Division of Minimally Invasive Surgery, Hokkaido University Hospital, Hokkaido, Japan

Tóm tắt

Background: The aim of this study was to evaluate the long-term nutritional state of patients with gastric cancer who underwent laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) using oblique jejunogastrostomy method (OJG). Methods: Medical records of 38 patients who underwent LPG-DTR using OJG (21 patients) or laparoscopic total gastrectomy with Roux-en-Y reconstruction (LTG-RY) (17 patients) between October 2011 and March 2018 were retrospectively reviewed. In these patients, clinicopathologic variables were analyzed using propensity score matching for age, sex, body mass index, American Society of Anesthesiologists physical state, clinical stage, and lymph node dissection. Operative outcomes and postoperative nutritional status were compared between the 2 groups. Results: A total of 16 patients were matched to analyze the LPG-DTR and LTG-RY groups. The serum hemoglobin, total protein, and albumin levels at 12 months postoperatively (P=0.008, 0.034, and 0.049) and serum hemoglobin level at 24 months (P=0.025) in the LPG-DTR group was significantly superior to those in the LTG-RY group. Conclusions: The postoperative nutritional status as long-term outcomes of patients who underwent LPG-DTR using OJG was significantly superior to those who underwent LTG-RY. The results hereby presented suggest that LPG-DTR using OJG for gastric cancer produces better postoperative nutritional status.

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Tài liệu tham khảo

Ahn, 2011, Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period, Br J Surg, 98, 255, 10.1002/bjs.7310

Wu, 2009, Stomach carcinoma incidence patterns in the united states by histologic type and anatomic site, Cancer Epidemiol Biomarkers Prev, 18, 1945, 10.1158/1055-9965.EPI-09-0250

Steevens, 2010, Trends in incidence of oesophageal and stomach cancer subtypes in Europe, Eur J Gastroenterol Hepatol, 22, 669

Dassen, 2010, Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands, Eur J Cancer, 46, 1101, 10.1016/j.ejca.2010.02.013

2017, Janapease gastric cancer treatment guidelines 2014 (ver.4), Gastric Cancer, 20, 1, 10.1007/s10120-016-0622-4

Giacopuzzi, 2017, Western strategy for EGJ carcinoma, Gastric Cancer, 20, 60, 10.1007/s10120-016-0685-2

Ahn, 2013, Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer, Gastric Cancer, 16, 282, 10.1007/s10120-012-0178-x

Rosa, 2018, Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG), Gastric Cancer, 21, 845, 10.1007/s10120-018-0804-3

Aikou, 1988, Antrum preserving double tract method for reconstruction following proximal gastrectomy, Jpn J Surg, 18, 114, 10.1007/BF02470857

Uyama, 1995, Laparoscopic and minilaparotomy proximal gastrectomy and esophagogastrostomy: Technique and case report, Surg Laparosc Endosc, 5, 5

Ahn, 2014, Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer, Gastric Cancer, 17, 562, 10.1007/s10120-013-0303-5

Kim, 2016, Laparoscopy-assisted proximal gastrectomy with double tract anastomosis is beneficial for vitamin B12 and iron absorption, Anticancer Res, 36, 4753, 10.21873/anticanres.11031

Hong, 2016, A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy, Surg Endosc, 30, 2396, 10.1007/s00464-015-4490-5

Aburatani, 2017, Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD, Surg Endosc, 31, 4848, 10.1007/s00464-017-5539-4

Tanaka, 2017, Laparoscopic proximal gastrectomy with oblique jejunogastrostomy, Langenbecks Arch Surg, 402, 995, 10.1007/s00423-017-1587-4

2011, Japanese classification of gastric carcinoma: 3rd, English edition, Gastric Cancer, 14, 101, 10.1007/s10120-011-0041-5

Clavien, 2009, The Clavien-Dindo classification of surgical complications: five-year experience, Ann Surg, 250, 187, 10.1097/SLA.0b013e3181b13ca2

Dindo, 2004, Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey, Ann Surg, 240, 205, 10.1097/01.sla.0000133083.54934.ae

Ebihara, 2013, Outcome of functional end-to-end esophagojejunostomy in totally laparoscopic total gastrectomy, Langenbecks Arch Surg, 398, 475, 10.1007/s00423-013-1051-z

Kyogoku, 2018, Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study, Langenbecks Arch Surg, 403, 463, 10.1007/s00423-018-1678-x

Fujimoto, 2020, Double-tract reconstruction designed to allow more food flow to the remnant stomach after laparoscopic proximal gastrectomy, World J Surg, 10.1007/s00268-020-05496-0

Jung, 2017, Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer, Surg Endosc, 31, 3961, 10.1007/s00464-017-5429-9

Park, 2018, Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy in terms of nutritional status or quality of life in early gastric cancer patients, Eur J Surg Oncol, 44, 1963, 10.1016/j.ejso.2018.08.014

Yamashita, 2019, Preservation of physiological passage through the remnant stomach prevents postoperative malnutrition after proximal gastrectomy with double tract reconstruction, Surg Today, 49, 748, 10.1007/s00595-019-01799-5

Takase, 2003, Quantitative evaluation of reconstruction methods after gastrectomy using a new type of examination: digestion and absorption test with stable isotope 13 C-labeled lipid compound, Gastric Cancer, 6, 134, 10.1007/s10120-003-0238-3

Kosuga, 2014, Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach, Ann Surg Oncol, 21, 2028, 10.1245/s10434-014-3520-1