P-097 - Double tract reconstruction after laparoscopic proximal gastrectomy; its procedure and short-term results

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Gastric Cancer
Surgery and/or Radiotherapy of Cancer
Presenter K. Kojima
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors K. Kojima, M. Inokuchi, S. Otuki
  • Tokyo Medical and Dental University, Bunkyo-ku/JP

Abstract

Introduction

Proximal gastrectomy 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 laparoscopic proximal gastrectomy (LPG) with double-tract reconstruction (DTR) for proximal early gastric cancer (EGC), and to evaluate the technical feasibility, safety, and short-term surgical outcomes after LPG.

Methods

Since March 2013, we have utilized DTR after LPG. Reverse Trendelenburg position and 5-port technique are utilized. After lymphadenectomy and resecting proximal stomach with a linear stapler, they are externalized from the umbilical wound, which is extended to 4 cm. An intracorporeal purse-string suture is performed using detachable ENDO-PSD. The distal end of esophagus is transected, and the anvil head of a 25 mm circular stapler is fixed in it. Jejunum 25 cm distal to the ligament of Treitz was transected and circular stapler is inserted in the distal jejunum. Pneumoperitoneum is re-established, and the distal jejunum is brought up in antecolic fashion, then esophagojejunostomy is performed. The jejunal stump is closed using a linear stapler. Jejunogastrostomy side to side is performed 15 cm distal to esophagojejunostomy, to which 20 cm distal jejunojejunostomy side to side is performed. A linear stapler is used in both anastomoses. Mesenteric gaps and Petersen's defect are closed with non-absorbable running suture.

Results

This procedure has been performed to 26 patients to date. The median operation time and blood loss were 356 min and 153 ml. One patient experienced pancreatic fistula and one patient pneumonia (Clavien-Dindo classification grade IIIa), but other complications such as anastomosis leakage and stenosis have not been observed. The median day of first oral intake and postoperative hospital stay were 4 and 9 days.

Conclusion

Short-term results of DTR after LPG are acceptable, however, further assessment of long-term results is needed.