Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach.

Abstract

A novel double-flap esophagogastrostomy technique developed to prevent reflux after proximal gastrectomy was applied to laparoscopic proximal gastrectomy (LPG), and the clinical outcomes of this technique (LPG-DFT) were evaluated and compared to those of laparoscopic total gastrectomy (LTG). This retrospective study of 90 patients with early gastric cancer (EGC) in the upper third of the stomach compared surgical outcomes, postoperative endoscopic findings, and nutritional status between two procedure groups, LPG-DFT (n = 43) and LTG (n = 47). The association between morbidity and surgical procedure was analyzed by controlling for body mass index (BMI). Mean operation time was significantly higher for LPG-DFT than LTG (386.5 vs. 316.3 min, P < 0.001). The morbidity and the frequency of anastomotic complications were lower, although not significantly, for LPG-DFT than LTG (7.0 vs. 21.3%, P = 0.073; and 4.7 vs. 17.2%, P = 0.093). Median postoperative hospital stay was significantly shorter for LPG-DFT than LTG (10 vs. 13 days, P = 0.002). The LPG-DFT procedure was identified as the most significant independent predictor of low morbidity after adjustment for BMI (P = 0.028, OR = 0.232, 95% CI 0.047-0.862). LTG induced more severe reflux esophagitis than LPG-DFT (14.9% vs. 2.3%, P = 0.06). The mean baseline weight, total protein, and hemoglobin were significantly higher with LPG-DFT than with LTG (P < 0.05). LPG-DFT is a better surgical procedure for treating upper-third EGC than LTG in terms of morbidity, postoperative hospital stay, and postoperative nutritional status.