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KMID : 0914820150150030191
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Journal of the Korean Gastric Cancer Association
2015 Volume.15 No. 3 p.191 ~ p.200
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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
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Huh Yeon-Ju
Lee Hyuk-Joon
Oh Seung-Young
Lee Kyung-Goo
Yang Jun-Young
Ahn Hye-Seong
Suh Yun-Suhk
Kong Seong-Ho
Lee Kuhn-Uk
Yang Han-Kwang
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Abstract
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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.
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KEYWORD
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Stomach neoplasms, Laparoscopy, Gastrectomy
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