S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Laparoscopic double tract proximal gastrectomy for proximal early gastric cancer
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- gastric cancer; laparoscopy; proximal gastrectomy; double tract recontruction; proximal EGC
- 학위논문 (석사)-- 서울대학교 대학원 : 의학과 외과학 전공, 2013. 2. 김형호.
- Background: LAPG is not routinely performed because it is associated with increased reflux symptoms and anastomotic strictures. The purpose of this study is to describe a novel method of laparoscopy-assisted proximal gastrectomy (LAPG) with double tract reconstruction (DTR) for proximal early gastric cancer (EGC), and to evaluate the technical feasibility, safety, and short-term surgical outcomes, especially reflux symptoms, after LAPG.
Methods: Retrospective review of the prospective cohort data of 43 patients who presented to a single tertiary hospital from June 2009 through April 2012 and underwent LAPG with DTR for proximal EGC. The data of this prospective cohort were analyzed, and the reflux symptoms, clinicopathologic characteristics, surgical outcomes, postoperative morbidities and mortalities, and follow-up findings were analyzed.
Results: The mean surgical time was 180.7 minutes
mean estimated blood loss, 120.4 mL
mean length of the proximal resection margin, 4.13 cm
mean number of retrieved lymph nodes, 41.2
and mean postoperative hospital stay, 7.1 days. Early complication rate was 11.6% (n = 5)
major complication (grade higher than Clavien-Dindo IIIa) occurred in 1 patient (2.3%). Late complication rate was 11.6% (n = 5): 2 patients had esophagojejunostomy stenosis, which was successfully treated with fluoroscopic balloon dilatations
1, chylous ascites
and 2 had Visick grade II reflux symptoms (4.6%), managed by medication during the mean follow-up period of 21.6 months.
Conclusion: DTR after LAPG is a feasible, simple, and novel reconstruction method with excellent postoperative outcomes in terms of preventing reflux symptoms. Its clinical applicability must be validated by prospective randomized trials.