Masaki Aizawa1, Hiroshi Yabusaki2, Koji Nakada3, Atsushi Matsuki2, Takeo Bamba2, Satoru Nakagawa2. 1. Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3, Kawagishicho, Niigata City, 951-8566, Japan. maizawa@niigata-cc.jp. 2. Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3, Kawagishicho, Niigata City, 951-8566, Japan. 3. Department of Laboratory Medicine, The Jikei University School of Medicine, Tokyo City, Japan.
Abstract
PURPOSE: While proximal gastrectomy is being performed increasingly frequently for the treatment of gastric cancer, a standard reconstruction method to obtain optimal postoperative quality of life (QOL) still remains to be established. We modified the original esophagogastrostomy technique by introducing an additional posterolateral fundoplication (PLF) technique to minimize the risk of reflux esophagitis in patients undergoing proximal gastrectomy. The aim of this study was to clarify the clinical benefit of PLF. METHODS: A retrospective analysis of the database was conducted to evaluate the effects of PLF. The data were compared between 44 patients in whom PLF was performed (PLF group) and 17 patients in whom conventional esophagogastrostomy without PLF was performed (C group). A number of incidence of postoperative reflux esophagitis and symptoms were assessed by findings of endoscopic examination and the PGSAS-45 questionnaire, respectively. RESULTS: The incidence of grade B or worse esophagitis after surgery was significantly lower in the PLF group than in the C group (0% vs. 58.8%, P < 0.01). The score for the esophageal reflux subscale, as the main outcome measure of PGSAS-45, was significantly better in the PLF group (PLF: 1.5 vs C: 2.4, P < 0.01). Cohen's d value was 1.75, which suggested a rather large effect size. Postoperative benign anastomotic stricture was encountered in 10 cases (22.7%) of the PLF group and 4 cases (23.5%) of the C group, all of whom were successfully treated by brief endoscopic mechanical dilatation. CONCLUSION: PLF is an expedient procedure for reconstruction after proximal gastrectomy.
PURPOSE: While proximal gastrectomy is being performed increasingly frequently for the treatment of gastric cancer, a standard reconstruction method to obtain optimal postoperative quality of life (QOL) still remains to be established. We modified the original esophagogastrostomy technique by introducing an additional posterolateral fundoplication (PLF) technique to minimize the risk of reflux esophagitis in patients undergoing proximal gastrectomy. The aim of this study was to clarify the clinical benefit of PLF. METHODS: A retrospective analysis of the database was conducted to evaluate the effects of PLF. The data were compared between 44 patients in whom PLF was performed (PLF group) and 17 patients in whom conventional esophagogastrostomy without PLF was performed (C group). A number of incidence of postoperative reflux esophagitis and symptoms were assessed by findings of endoscopic examination and the PGSAS-45 questionnaire, respectively. RESULTS: The incidence of grade B or worse esophagitis after surgery was significantly lower in the PLF group than in the C group (0% vs. 58.8%, P < 0.01). The score for the esophageal reflux subscale, as the main outcome measure of PGSAS-45, was significantly better in the PLF group (PLF: 1.5 vs C: 2.4, P < 0.01). Cohen's d value was 1.75, which suggested a rather large effect size. Postoperative benign anastomotic stricture was encountered in 10 cases (22.7%) of the PLF group and 4 cases (23.5%) of the C group, all of whom were successfully treated by brief endoscopic mechanical dilatation. CONCLUSION: PLF is an expedient procedure for reconstruction after proximal gastrectomy.
Authors: Ulrich Ronellenfitsch; Sara Najmeh; Amin Andalib; Rushika M Perera; Mathieu C Rousseau; David S Mulder; Lorenzo E Ferri Journal: Ann Surg Oncol Date: 2014-09-12 Impact factor: 5.344
Authors: Michitaka Honda; Sandra L Wong; Mark A Healy; Toshifusa Nakajima; Masayuki Watanabe; Shingo Fukuma; Shunichi Fukuhara; John Z Ayanian Journal: J Cancer Date: 2017-07-05 Impact factor: 4.207