Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Gastric Cancer. 2019 Sep;22(5):1036-1043. doi: 10.1007/s10120-019-00940-0. Epub 2019 Mar 6.
Double-flap technique (DFT) has received increased attention as an anastomotic procedure preventing reflux esophagitis after laparoscopic proximal gastrectomy (LPG) for upper-third gastric cancer. However, incidence of anastomotic stricture still remains high. This study was a retrospective review aimed to demonstrate details of surgical outcomes and to assess risk factors for anastomotic complications using pre-operative CT image after LPG with DFT (LPG-DFT).
Patient background data, surgical outcomes, post-operative courses, and complications for patients who underwent LPG-DFT from January 2013 to June 2017 were collected. In addition to the details of short-term outcomes, risk factors for anastomotic stricture and gastroesophageal reflux were analyzed.
The study sample was 147 patients, including 139 patients with upper-third gastric cancer and 8 patients with submucosal tumor of the upper-third stomach. The overall morbidity rate was 12.2% (18/147), and 97.3% (143/147) of the patients achieved R0 resection. Twelve (8.3%) patients required endoscopic balloon dilatation for anastomotic stenosis, and six (4.2%) suffered regurgitation grade ≥ B in the Los Angeles classification. Multivariate analysis revealed that diameter of the esophagus < 18 mm on pre-operative CT image and the presence of short-term complications were found to be independent risk factors for post-operative anastomotic stenosis. No specific risk for gastroesophageal reflux was identified.
The incidence rate of anastomotic complications after LPG-DFT was far lower than that reported after conventional esophagogastrostomy. Alternative anastomotic method may be considered for patients with diameter of the esophagus < 18 mm on pre-operative CT image. Prevention of short-term complications may lessen post-operative stricture.
双瓣技术（DFT）作为腹腔镜近端胃切除术（LPG）治疗上三分之一胃癌后预防反流性食管炎的吻合术受到了越来越多的关注。然而，吻合口狭窄的发生率仍然很高。本研究回顾性分析了 LPG-DFT 术后的手术结果，并利用术前 CT 图像评估了吻合口并发症的危险因素。
收集 2013 年 1 月至 2017 年 6 月期间接受 LPG-DFT 的患者的患者背景资料、手术结果、术后过程和并发症。除了短期结果的详细信息外，还分析了吻合口狭窄和胃食管反流的危险因素。
研究样本为 147 例患者，其中上三分之一胃癌 139 例，上三分之一胃黏膜下肿瘤 8 例。总发病率为 12.2%（18/147），147 例患者均达到 R0 切除。12 例（8.3%）患者因吻合口狭窄需行内镜球囊扩张，6 例（4.2%）患者洛杉矶分级反流分级≥B。多因素分析显示，术前 CT 图像食管直径<18mm 和短期并发症的存在是术后吻合口狭窄的独立危险因素。未发现胃食管反流的特定危险因素。
LPG-DFT 后吻合口并发症的发生率远低于传统的食管胃吻合术。对于术前 CT 图像食管直径<18mm 的患者，可考虑采用替代吻合方法。预防短期并发症可能会减轻术后狭窄。
