Modified Gastroesophageal Anastomosis in Proximal Gastrectomy

Abstract

Background: Radical proximal gastrectomy is remaining to be a widely applied operative method, especially for gastric cancer, that involves mucosa and submucosa layer of the stomach wall. Postgastrectomy syndromes after proximal gastrectomy are still more or less unavoidable. That is why, the selecting an ideal alimentary canal reconstructive pattern to elevate the quality of life has become more critical. Method(s): Three hundred twenty-four patients with upper third gastric and gastroesophageal cancers were admitted consecutively with curative intent in a clinic of National Cancer Institute of Ukraine, between May 2007 and May 2012. All patients were randomized in three groups by type of gastroesofageal anastomosis use during proximal gastrectomy (stapler anastomosis (SA), hand-sutured anastomosis by Ivor Lewis (HSA) or modified antireflux hand-sutured anastomosis (MAHSA)). Result(s): Endoscopic control at 1 year follow-up of SA group showed reflux esophagitis with the following distributions: 40.6%, 30.2% and 13.2%; the same control in HSA group show 17.3%, 13.5 % and 8.6% for grade A, B and C respectively (according to Los Angeles Classification of Esophagitis). In contrast endoscopic control of MAHSA group showed reflux disease grade A and B only in 14.1% and 1.7% respectively. The evaluation scores measured by the EORTC QOL gastric cancerspecific questionnaire (QLQ-25) for eating solid, liquid food and enjoying of meals were better in group MAHSA than in SA group patients: 2.1 +/-0.1; 1.3 +/-0.1 and 1.1 +/-0.05 vs 2.4 +/-0.2; 1.7 +/-0.2; 1.8 +/-0.2 respectively. The evaluation scores for acid indigestion or heartburn and acid or bile coming into mouth in main group MAHSA were 1.2 +/-0.08; 1.2 +/-0.08 whereas in groups HSA and SA they were 1.8 +/-0.1; 1.8 +/-0.2 and 2.2 +/-0.2; 1.8 +/-0.1 respectively (p < 0.05). Conclusion(s): Our data showed that the presented modified method of esophagogastric anastomosis forming is a safe, easy to implement and effective in preventing the development of reflux after PGE for cancer of the upper third of the stomach.