Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer

Do Joong Park; Young Suk Park; Sang-Hoon Ahn; Hyung-Ho Kim

doi:10.4166/kjg.2017.70.3.134

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Park, Park, Ahn, and Kim: Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer

Review Article

Korean J Gastroenterol 2017;70(3):134-140.

Published online: 4 October 2017

DOI: https://doi.org/10.4166/kjg.2017.70.3.134

Laparoscopic Proximal Gastrectomy as a Surgical Treatment for Upper Third Early Gastric Cancer

Do Joong Park^1,², Young Suk Park², Sang-Hoon Ahn², Hyung-Ho Kim^1,²

¹Department of Surgery, Seoul National University College of Medicine, Seoul Korea

²Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to: Do Joong Park, Department of Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. Tel: +82-31-787-7099, Fax: +82-31-787-4078, E-mail: djpark@snubh.org

Received 17 August 2017 Revised 14 September 2017 Accepted 14 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, the incidence of upper third gastric cancer has increased, and with it the number of endoscopic submucosal dissection (ESD) procedures performed has been increasing. However, if ESD is not indicated or non-curable, surgical treatment may be necessary. In the case of lower third gastric cancer, it is possible to preserve the upper part of the stomach; however, in the case of upper third gastric cancer, total gastrectomy is still the standard treatment option, regardless of the stage. This is due to the complications associated with upper third gastric cancer, such as gastroesophageal reflux after proximal gastrectomy rather than oncologic problems. Recently, the introduction of the double tract reconstruction method after proximal gastrectomy has become one of the surgical treatment methods for upper third early gastric cancer. However, since there has not been a prospective comparative study evaluating its efficacy, the ongoing multicenter prospective randomized controlled trial (KLASS-05) comparing laparoscopic proximal gastrectomy with double tract reconstruction and laparoscopic total gastrectomy is expected to be important for determining the future of treatment of upper third early gastric cancer.

Keywords: Stomach neoplasm, Laparoscopies, Gastrectomies, Surgical anastomosis

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Fig. 1.

Upper third early gastric cancer.

Fig. 2.

Roux-en-Y esophagojejunostomy after laparoscopic total gas-trectomy.

Fig. 3.

Direct esophagogastrostomy after laparoscopic proximal gas-trectomy.

Fig. 4.

Double tract reconstruction after laparoscopic proximal gas-trectomy.

Table 1.

Key Articles for Therapeutic Options of Upper Third Early Gastric Cancer

	Key articles
	Author	Year	Title	Journal
Endoscopic submucosal dissection	Chung et al.¹⁵	2009	Therapeutic outcomes in 1000 cases of endoscopic submucosal dissection for early gastric neoplasms: Korean ESD Study Group multicenter study	Gastrointest Endosc
	Ahn et al.¹⁶	2011	Procedure time of endoscopic submucosal dissection according to the size and location of early gastric cancers: analysis of 916 dissections performed by 4 experts	Gastrointest Endosc
Oncologic outcomes of proximal gastrectomy for early gastric cancer	Harrison et al.²⁴	1998	Total gastrectomy is not necessary for proximal gastric cancer	Surgery
	Nozaki et al.²⁵	2013	Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy	World J Surg
	Ichikawa et al.²⁷	2014	Long-term outcomes of patients who underwent limited proximal gastrectomy	Am J Surg
Proximal gastrectomy with double tract reconstruction vs. Total gastrectomy	Jung et al.⁵⁰	2017	Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer	Surg Endosc

Table 2.

Studies of Laparoscopic Proximal Gastrectomy for Upper Third Early Gastric Cancer

Anastomosis	Author	Patients	Operation time (min)	Blood loss (mL)	Complication (%)	Reflux (%)	Survival (%)
Esophagogastrostomy	Ahn et al.²⁹	50	216.3	115.8	24.0	32.0	>95
Gastric tube	Yasuda et al.³²	25	286.4	294.2	16.0	4.4
Fundoplication	Sakuramoto et al.³⁷	26	293.0	119.0	7.7	20.0	>95
Jejunal Interposition	Kinoshita et al.⁴¹	22	233.0	20.0	27.0	0
	Yasuda et al.³²	21	268.8	307.4	28.6	5.0
Double Tract Reconstruction	Sakuramoto et al.³⁷	10	269.0	107.0	20.0	25.0	>95
	Ahn et al.⁴²	43	180.7	120.4	11.6	4.6	100

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