Omori Takeshi, Hara Hisashi, Yanagimoto Yoshitomo, Shinno Naoki, Masuike Yasunori, Kanemura Takashi, Wada Hiroshi, Yasui Masayoshi, Ohue Masayuki, Miyata Hiroshi
Department of Gastroenterological Surgery Osaka International Cancer Institute Osaka Japan.
Department of Gastroenterological Surgery Osaka International Medical and Science Center Osaka Japan.
Ann Gastroenterol Surg. 2024 Oct 9;9(2):251-262. doi: 10.1002/ags3.12864. eCollection 2025 Mar.
Preventing gastroesophageal reflux after proximal gastrectomy for proximal gastric and esophagogastric junction cancer remains challenging due to the lack of standardized reconstructive techniques. The double flap technique (DFT) in valvuloplastic esophagogastrostomy prevents reflux esophagitis but is less effective in esophagogastric junction cancer because of negative pressure on the inferior mediastinum. We developed the U-shaped flap technique (UFT) to enhance the anti-reflux efficacy.
This study analyzed data from patients who underwent minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer between August 2014 and May 2022, using a prospectively maintained database. We compared DFT and UFT for short- and long-term outcomes, focusing on gastroesophageal reflux, using one-to-one propensity score matching to control for patient-related variables.
Among 217 eligible patients, 205 (100 in DFT, 105 in UFT) completed a 1-year follow-up. After propensity score matching, we selected 42 pairs of patients who underwent DFT and UFT. UFT had significantly shorter operative time ( = 0.044), similar blood loss, and similar morbidity. The UFT group had significantly fewer reflux symptoms (0% vs. 14.3%, = 0.0011) and endoscopic Los Angeles grade B or higher reflux esophagitis (0% vs. 14.3%, = 0.0011) than the DFT group. In lower mediastinal reconstructions for esophagogastric junction cancer, UFT showed a reduced incidence of reflux esophagitis.
Our study indicates that the U-shaped flap technique (UFT) offered significant advantages in reducing postoperative reflux symptoms and endoscopic esophagitis, in a cohort of patients with proximal gastric and esophagogastric junction cancer.
由于缺乏标准化的重建技术，近端胃切除术治疗近端胃癌和食管胃交界癌后预防胃食管反流仍然具有挑战性。瓣膜成形术式食管胃吻合术中的双瓣技术（DFT）可预防反流性食管炎，但由于对下纵隔产生负压，对食管胃交界癌的效果较差。我们开发了U形瓣技术（UFT）以提高抗反流效果。
本研究分析了2014年8月至2022年5月期间接受微创近端胃切除术治疗近端胃癌和食管胃交界癌患者的数据，使用前瞻性维护的数据库。我们比较了DFT和UFT的短期和长期结果，重点关注胃食管反流，采用一对一倾向评分匹配来控制患者相关变量。
在217例符合条件的患者中，205例（DFT组100例，UFT组105例）完成了1年随访。倾向评分匹配后，我们选择了42对接受DFT和UFT的患者。UFT的手术时间明显更短（P = 0.044），失血量相似，发病率相似。UFT组的反流症状明显少于DFT组（0%对14.3%，P = 0.0011），内镜下洛杉矶分级为B级或更高的反流性食管炎也明显更少（0%对14.3%，P = 0.0011）。在食管胃交界癌的下纵隔重建中，UFT显示反流性食管炎的发生率降低。
我们的研究表明，在近端胃癌和食管胃交界癌患者队列中，U形瓣技术（UFT）在减少术后反流症状和内镜下食管炎方面具有显著优势。
