Amini Neda, Kinoshita Takahiro, Arrieta Manuel, Yoshida Mitsumasa, Nagata Hiromi, Habu Takumi, Komatsu Masaru, Yura Masahiro
Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
Department of Surgical Oncology, North Shore/Long Island Jewish, Northwell Health, New Hyde Park, NY.
Surg Laparosc Endosc Percutan Tech. 2025 Apr 1;35(2):e1322. doi: 10.1097/SLE.0000000000001322.
Esophagogastrostomy is one of the reconstruction techniques after proximal gastrectomy, but reflux and esophagitis are significant concerns. We introduced a new robotic valvuloplasty technique (single-flap), taking advantage of robotic surgery to address these issues and simplify the technique, especially for tumors with esophageal invasion.
Between March 2022 and March 2024, patients who underwent robotic proximal gastrectomy with the single-flap technique were included. Based on the difficulty of the surgery, patients were divided into 2 groups: one with esophageal invasion requiring anastomosis in the mediastinum and the second group with tumors in the upper third of the stomach requiring anastomosis in the abdomen.
A total of 22 patients were included: 13 in the esophageal invasion group and 9 in the upper stomach group. The median size of esophageal invasion was 2 cm (1 to 3 cm). The median operative time was 320 minutes (esophageal invasion 326 vs. upper stomach 280 min, P =0.51), with a median blood loss of 35 g (31 vs. 38 g, P =0.19). No postoperative mortality, anastomotic leaks, reflux symptoms, or pancreatic fistulas were observed. Eighteen patients underwent endoscopic evaluation, and no sign of esophagitis was detected. Five patients (22.7%) developed grade III strictures requiring endoscopic balloon dilation (esophageal invasion 32.1% vs. upper stomach 22.2%; P =0.96).
Robotic proximal gastrectomy with single-flap valvuloplastic esophagogastrostomy is a safe and feasible option for gastroesophageal junction tumors with up to 3 cm of esophageal invasion.
食管胃吻合术是近端胃切除术后的重建技术之一，但反流和食管炎是重要问题。我们引入了一种新的机器人瓣膜成形术技术（单瓣法），利用机器人手术来解决这些问题并简化技术，特别是对于侵犯食管的肿瘤。
纳入2022年3月至2024年3月期间接受单瓣法机器人近端胃切除术的患者。根据手术难度，将患者分为两组：一组为侵犯食管需在纵隔内进行吻合，另一组为胃上三分之一部肿瘤需在腹部进行吻合。
共纳入22例患者：食管侵犯组13例，胃上部组9例。食管侵犯的中位长度为2 cm（1至3 cm）。中位手术时间为320分钟（食管侵犯组326分钟，胃上部组280分钟，P = 0.51），中位失血量为35 g（31 g对38 g，P = 0.19）。未观察到术后死亡、吻合口漏、反流症状或胰瘘。18例患者接受了内镜评估，未检测到食管炎迹象。5例患者（22.7%）出现III级狭窄，需要内镜下球囊扩张（食管侵犯组32.1%，胃上部组22.2%；P = 0.96）。
对于食管侵犯长度达3 cm的胃食管交界部肿瘤，单瓣瓣膜成形术式的机器人近端胃切除术是一种安全可行的选择。
