Reconstruction in Laparoscopic Proximal Gastrectomy for Esophagogastric Junction Carcinoma
Treatment strategy for esophagogastric junction (EGJ) carcinoma has been controversial for a long time.
Seiichiro Kanaya
Department of Gastrointestinal Surgery, Osaka Red Cross Hospital
5-30, Fudegasaki-cho, Tennoji-ku, Osaka, 543-8555, Japan
Purpose: Treatment strategy for esophagogastric junction (EGJ) carcinoma has been controversial for a long time. Standard operation, especially standard reconstruction method has not been established yet. We developed a new reconstruction method in laparoscopic proximal gastrectomy for EGJ carcinoma, which is a simple and safe procedure. In this paper, I explain our strategy and the technique of reconstruction for EGJ carcinoma.
Methods: Laparoscopic proximal gastrectomy with transhiatal lower esophagectomy is performed. In regards to the reconstruction, we have adopted two methods. One is our original esophagogastric tube (EGT) reconstruction with pseudo-fornix created by a no-knife linear stapler. It’s a simple and tension free procedure with only one anastomosis. However, its long-term outcome about reflux esophagitis is still unknown. Then, mainly for the patients who cannot take PPI lifelong, double-tract (DT) reconstruction is selected.
Results: From April 2011, we performed laparoscopic proximal gastrectomy with transhiatal or transthoracic/thoracoscopic esophagectomy in 33 patients with EGJ carcinoma. EGT reconstruction was done in 27 patients and DT was done in 6 patients. Median operation time was 306 min. in EGT and 377 in DT. Surgical complications included 1 anastomotic leakage and 3 anastomotic stenoses in EGT, and 1 anastomotic leakage in DT. Postoperative reflux symptoms are well controlled in all patients.
Conclusion: Laparoscopic esophagogastric tube reconstruction is a tension free and simple procedure with only one anastomosis. Although long-term follow-up and a larger number of patients are required, our procedures would be the treatment of choice for EGJ carcinoma.