Department of Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan.
Surg Endosc. 2013 Jan;27(1):146-53. doi: 10.1007/s00464-012-2401-6. Epub 2012 Jun 27.
The incidence of cancer in the proximal third of the stomach is increasing. Laparoscopic proximal gastrectomy (LPG) seems an attractive option for the treatment of early-stage proximal gastric cancer but has not gained wide acceptance because of technical difficulties, including the prevention of severe reflux. In this study, we describe our technique for LPG with jejunal interposition (LPG-IP) and evaluate its safety and feasibility.
In this retrospective analysis, we reviewed the data of patients with proximal gastric cancer who underwent LPG-IP (n = 22) or the same procedure with open surgery (OPG-IP; n = 68) between January 2008 and September 2011. Short-term surgical variables and outcomes were compared between the groups. The reconstruction method was the same in both groups, with creation of a 15 cm, single-loop, jejunal interposition for anastomosis.
There were no differences in patient or tumor characteristics between the groups. Operation time was longer in the LGP-IP group (233 vs. 201 min, p = 0.0002) and estimated blood loss was significantly less (20 vs. 242 g, p < 0.0001). The average number of harvested lymph nodes did not differ between the two groups (17 vs. 20). There also were no differences in the incidence of leakage at the esophagojejunostomy anastomosis (9.1 vs. 7.4%) or other postoperative complications (27 vs. 32%). The number of times additional postoperative analgesia was required was significantly less in the LPG-IP group compared with the OPG-IP group (2 vs. 4, p < 0.0001).
LPG-IP has equivalent safety and curability compared with OPG-IP. Our results imply that LPG-IP may lead to faster recovery, better cosmesis, and improved quality of life in the short-term compared with OPG-IP. Because of the limitations of retrospective analysis, a further study should be conducted to obtain definitive conclusions.
近端胃癌的发病率正在上升。腹腔镜近端胃切除术（LPG）似乎是治疗早期近端胃癌的一种有吸引力的选择，但由于技术困难，包括预防严重反流，尚未得到广泛接受。在这项研究中，我们描述了我们的 LPG 加空肠间置术（LPG-IP）的技术，并评估了其安全性和可行性。
在这项回顾性分析中，我们回顾了 2008 年 1 月至 2011 年 9 月期间接受 LPG-IP（n=22）或相同手术加开放手术（OPG-IP；n=68）治疗的近端胃癌患者的数据。比较两组患者的短期手术变量和结果。两组的重建方法相同，创建一个 15cm 的单环空肠间置吻合术。
两组患者的特征和肿瘤特征均无差异。LPG-IP 组的手术时间较长（233 分钟比 201 分钟，p=0.0002），估计出血量明显较少（20 克比 242 克，p<0.0001）。两组间淋巴结采集数量无差异（17 个比 20 个）。食管空肠吻合口漏的发生率也无差异（9.1%比 7.4%）或其他术后并发症（27%比 32%）。与 OPG-IP 组相比，LPG-IP 组需要额外术后镇痛的次数明显较少（2 次比 4 次，p<0.0001）。
LPG-IP 与 OPG-IP 具有相同的安全性和治愈率。我们的结果表明，与 OPG-IP 相比，LPG-IP 可能在短期内导致更快的恢复、更好的美容效果和提高生活质量。由于回顾性分析的局限性，需要进一步的研究来得出明确的结论。
