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Lee, Seo, Lee, and Yoon: Prediction of Reconstructive Procedure after Laparoscopy Assisted Distal Gastrectomy in Patients with Distal Early Gastric Cancer
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(2): 103-109.

Published online: 2 August 2010

DOI: https://doi.org/10.4174/jkss.2010.79.2.103

Prediction of Reconstructive Procedure after Laparoscopy Assisted Distal Gastrectomy in Patients with Distal Early Gastric Cancer

Seung Hun Lee, M.D., Kyung Won Seo, M.D., Sang Ho Lee, M.D., Ki Young Yoon, M.D.

Department of Surgery, Gospel Hospital, College of Medicine, Kosin University, Busan, Korea.

Corresponding author (yoonkiyoung@naver.com)

Received 2 March 2010       Accepted 5 April 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

Laparoscopy assisted distal gastrectomy (LADG) has been accepted as the best standard operative technique in early gastric cancer. But, no predictive indicators of reconstructive procedure were reported. Analyzing the reconstructive procedure after LADG according to location of the lesion, we, herein, suggest an alternative.

Methods

From May 2008 to May 2009, 55 patients with distal gastric cancer who underwent LADG were examined retrospectively. The group of 55 patients were assigned to two groups according to the reconstructive procedure undertaken: 41, Billroth I (BI); 14, Billroth II (BII). After measuring the distance between esophagogastric junction and tumor (ET) and between pyloric ring and tumor (PT), we found ET/(ET+PT).

Results

The mean±standard error time of ET in BI and BII group was 20.5±7.9 cm (5~38) and 13.9±6.7 cm (6~30). The mean±standard error time of PT in BI and BII group was 15.1±8.2 cm (2~36) and 22.6±9.1 cm (8~40). The mean±standard error time of ET/(ET+PT) in BI and BII group was 57.0±21.1% (16.1~95.0) and 39.1±19.0% (13.0~75.0). ET, PT and ET/(ET+PT) were correlated with reconstructive procedure (P=0.007, 0.006, 0.005). In comparative analysis of correlation between ET and reconstructive procedure, 95% confidence level in BI and BII group is 18.0~22.9 cm and 10.0~17.7 cm; between PT and reconstructive procedure, 12.5~17.7 cm and 17.4~27.8 cm; and between ET/(ET+PT) and reconstructive procedure, 51.1~64.4% and 28.1~50.0%.

Conclusion

In our study, predictive indicators of decision for reconstructive procedure in ET, PT, ET/(ET+PT) is 17.8~18.0 cm, 17.4~17.7 cm, 50.0~51.1%.

Keywords: Gastric cancer, Laparoscopy assisted distal gastrectomy, Reconstructive procedure

Figures and Tables

Fig. 1
(A) Endoscopic clipping at proximal and distal margin of the lesion. (B) Endoscopic tattooing on submucosa of the lesion. (C) X-ray finding after endoscopic clipping.
jkss-79-103-g001
Fig. 2
Relation between distance of the tumor from the esophagogastric junction (ET) and reconstructive procedure.
jkss-79-103-g002
Fig. 3
Relation between distance of the tumor from the pylorus (PT) and reconstructive procedure.
jkss-79-103-g003
Fig. 4
Relation between the proportion of distance of the tumor from esophagogastric junction (ET) to total length of the stomach (ET+PT) and reconstructive procedure.
jkss-79-103-g004
Table 1
Comparison of clinical characteristics between B I and B II reconstruction group
jkss-79-103-i001

*B I = Billroth I; †B II = Billroth II; ‡BWt. = body weight; §BMI = body mass index.

Table 2
Comparison of location of lesion between B I and B II reconstruction group
jkss-79-103-i002

*B I = Billroth I; †B II = Billroth II; ‡ET = distance between esophagogastric junction and tumor; §PT = distance between pylorus and tumor.

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