Nunobe Souya, Ida Satoshi
Department of Gastroenterological surgery Cancer Institute Ariake Hospital Tokyo Japan.
Ann Gastroenterol Surg. 2020 Jun 21;4(5):498-504. doi: 10.1002/ags3.12365. eCollection 2020 Sep.
Proximal gastrectomy (PG) is one of the function-preserving surgical methods for the treatment of upper gastric cancer. Favorable postoperative results have been reported in comparison with total gastrectomy. However, because there are challenges, such as postoperative reflux esophagitis, anastomotic stenosis, and residual food, appropriate selection of a reconstruction method is crucial. Some methods include esophagogastric anastomosis, including simple esophagogastrostomy, tube-like stomach esophagogastrostomy, side overlap with fundoplication by Yamashita, and double-flap technique, and reconstruction using the small intestine, including double-tract methods, jejunal interposition, and jejunal pouch interposition. However, standard reconstruction methods are yet to be established. PG has also been employed in early gastric cancer of the upper third of the stomach, and indications have also been extended to esophagogastric junction cancer, which has shown an increase in recent years. Although many retrospective studies have revealed the functional benefits or oncological safety of PG, the characteristics of each surgical procedure should be understood so that an appropriate reconstruction method, with a reflux prevention mechanism and minimal postoperative injury, can be selected.
近端胃切除术（PG）是治疗胃上部癌的保留功能的手术方法之一。与全胃切除术相比，已报道了良好的术后结果。然而，由于存在诸如术后反流性食管炎、吻合口狭窄和食物残留等挑战，合适地选择重建方法至关重要。一些方法包括食管胃吻合术，包括简单食管胃吻合术、管状胃食管胃吻合术、山下式胃底折叠侧侧吻合术和双瓣技术，以及使用小肠的重建方法，包括双道法、空肠间置术和空肠袋间置术。然而，标准的重建方法尚未确立。PG也已应用于胃上部三分之一的早期胃癌，其适应证也已扩展到近年来呈上升趋势的食管胃交界癌。尽管许多回顾性研究揭示了PG的功能益处或肿瘤学安全性，但应了解每种手术方法的特点，以便选择一种具有防反流机制且术后损伤最小的合适重建方法。
