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Kwag, Jung, Lee, Jung, Park, Choi, Hong, Jung, Joo, and Ha: The Risk Factors of Reflux Complication after Gastrectomy for Proximal Gastric Cancer
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2010; 79(4): 246-252.

Published online: 31 October 2010

DOI: https://doi.org/10.4174/jkss.2010.79.4.246

The Risk Factors of Reflux Complication after Gastrectomy for Proximal Gastric Cancer

Seung-Jin Kwag, M.D.1, 2, 3, Sang-Ho Jung, M.D.1, 2, 3, Young-Jun Lee, M.D.1, 2, 3, Chi-Young Jung, M.D.1, 2, 3, Soon-Tae Park, M.D.1, 2, 3, Sang-kyeong Choi, M.D.1, 2, 3, Soon-Chan Hong, M.D.1, 2, 3, Eun-Jung Jung, M.D.1, 2, 3, Young-Tae Joo, M.D.1, 2, 3, Woo-Song Ha, M.D.1, 2, 3

1Department of Surgery, Gyeongsang National University Hospital, Jinju, Korea.

2Gyeongnam Regional Cancer Center, Jinju, Korea.

3Gyeongsang Institute of Health Sciences, Jinju, Korea.

Corresponding author (orangejulia@naver.com)

Received 10 April 2010       Accepted 13 May 2010

Copyright © 2010 The Korean Surgical Society

Abstract

Purpose

The aim of this study was to investigate the risk factors of reflux associated complications (reflux symptoms, reflux esophagitis, and esophageal stricture) after gastrectomy for proximal gastric cancer.

Methods

150 patients with proximal gastric cancer were included from January 2005 to December 2008. Their medical and surgical records were retrospectively analyzed concerning clinical and pathologic characteristics, operation methods, morbidity, reflux associated complications and nutritional states.

Results

Tumor sizes and operation methods were statistically significant in univariate analysis of risk factors for reflux associated complications (P<0.05). However, only operation methods were statistically significant in multivariate analysis (P=0.00). We, thus, compared operation methods. There were no significant differences in morbidity, body weight, hemoglobin, serum cholesterol, protein and albumin between total gastrectomy groups and proximal gastrectomy groups (P>0.05). However, reflux complications were significantly more common in proximal gastrectomy groups (72.4%) than in total gastrectomy groups (29.5%). Severe reflux esophagitis (LA classification C or D) was found in only proximal gastrectomy groups.

Conclusion

Total gastrectomy is favorable for proximal early gastric cancer in terms of reduced esophageal reflux complications.

Keywords: Stomach neoplasm, Gastroesophageal reflux, Esophagitis, Esophageal stenosis, Total gastrectomy

Figures and Tables

Table 1
Risk factors of reflux complication
jkss-79-246-i001

*OR = odd ratio; †NS = not significant; ‡BMI = body mass index; §OG = open gastrectomy; ∥LG = laparoscopic gastrectomy; TG = total gastrectomy; **PG = proximal gastrectomy.

Table 2
Comparison of pathological characteristics, morbidity and mortality
jkss-79-246-i002

*TG = total gastrectomy; †PG = proximal gastrectomy; ‡LN = nymph node.

Table 3
Changes of clinical parameters
jkss-79-246-i003

*OP = operation; †TG = total gastrectomy; ‡PG = proximal gastrectomy. Results analyzed by paired t-test and values are mean±standard deviation.

Table 4
Comparison of reflux complications
jkss-79-246-i004

*TG = total gastrectomy; †PG = proximal gastrectomy; ‡OR = odd ratio; §PPI = proton pimp inhibitor.

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