Gastric Surgery Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, 277-8577, Japan.
Langenbecks Arch Surg. 2021 Mar;406(2):479-489. doi: 10.1007/s00423-020-02076-7. Epub 2021 Jan 15.
As the frequency of cancer in the proximal stomach or around the esophagogastric junction (EGJ) increases worldwide, the use of laparoscopic proximal gastrectomy (LPG) has expanded. This study evaluated the safety of LPG with double-tract reconstruction (LPG-DT) and the resulting quality of life (QOL) of patients.
In this retrospective cohort study, we reviewed the data of patients who underwent LPG-DT via linear-stapled esophagojejunostomy for gastric or EGJ cancer between 2013 and 2019, and outcomes were compared with those of laparoscopic total gastrectomy with Roux-en-Y reconstruction (LTG-RY) peMME000372rformed over the same period. Surgical outcomes, changes of nutritional parameters, and chronological QOL as evaluated using the Postgastrectomy Syndrome Assessment Scale (PGSAS-37) questionnaire were compared in the propensity-matched cohorts.
In total, 289 patients (99 LPG-DT and 190 LTG-RY) were eligible and the outcomes were evaluated in the propensity-matched cohorts (n = 75 each). Operative time and the incidence of complications (≥ grade III) were comparable. Reflux esophagitis was more frequent in the LPG-DT group (8.0% vs. 0%), whereas the incidence of anastomotic stricture did not differ. The percentage rates of body weight loss and hemoglobin reduction were lower in the LPG-DT group at any time point within postoperative 2 years but show no statistical differences. In PGSAS-37 (n = 26, n = 23), the diarrhea and quality of ingestion scores were slightly better in the LPG-DT group.
The present study suggested that our LPG-DT is feasible and safe in appropriately selected patients, and it may provide slightly better outcomes in nutrition and QOL compared with LTG-RY.
随着全球范围内近端胃或食管胃结合部（EGJ）癌症的发病率增加，腹腔镜近端胃切除术（LPG）的应用范围不断扩大。本研究评估了双道重建（LPG-DT）腹腔镜近端胃切除术的安全性，以及由此带来的患者生活质量（QOL）。
在这项回顾性队列研究中，我们回顾了 2013 年至 2019 年间接受通过线性吻合食管空肠吻合术行 LPG-DT 治疗的胃或 EGJ 癌症患者的数据，并与同期行腹腔镜全胃切除术加 Roux-en-Y 重建（LTG-RY）的患者进行了比较。在倾向评分匹配的队列中比较了手术结果、营养参数的变化以及使用胃切除术后综合征评估量表（PGSAS-37）问卷评估的时间顺序 QOL。
共有 289 例患者（99 例 LPG-DT 和 190 例 LTG-RY）符合条件，并在倾向评分匹配的队列中评估了结果（n=75 例）。手术时间和并发症（≥3 级）的发生率相当。反流性食管炎在 LPG-DT 组更常见（8.0% vs. 0%），而吻合口狭窄的发生率没有差异。在术后 2 年内的任何时间点，LPG-DT 组的体重减轻和血红蛋白减少百分比均较低，但无统计学差异。在 PGSAS-37（n=26，n=23）中，LPG-DT 组的腹泻和摄入质量评分稍好。
本研究表明，我们的 LPG-DT 在适当选择的患者中是可行且安全的，与 LTG-RY 相比，它可能在营养和 QOL 方面提供稍好的结果。
