Modified Gastroesophageal Anastomosis in Proximal Gastrectomy

Abstract

Background. Radical proximal gastrectomy (PGE) is remaining to be a widely applied operative method, especially forgastric cancer, that involves mucosa and submucosa layerof the stomach wall. Selecting an ideal alimentary canalreconstructive pattern to elevate the quality of life has become more critical.Methods. Between May 2008 and May 2013, 324 patientswere randomized in three groups by type of gastroesofagealanastomosis used during PGE: stapler anastomosis (SA),hand‐sutured standard anastomosis by Ivor Lewis (HSA) ormodifed antire?ux hand‐sutured anastomosis (MA).Results. Endoscopic control at 1 year follow‐up of SA groupshowed re?ux esophagitis with the following distributions:40.6%, 30.2% and 13.2%; the same control in HSA groupshowed 17.3%, 13.5% and 8.6% for grade A, B and C, respectively. In contrast, endoscopic control of MA groupshowed re?ux disease grade A and B only in 14.1% and1.7%, respectively. The evaluation scores measured by theEORTC QOL were better in group HSA than in SA group patients: 2.1 ± 0.1; 1.3 ± 0.1and 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 maingroup HSA were 1.2 ± 0.08; 1.2 ± 0.08 whereas in groups HSAand SA they were 1.8 ± 0.1; 1.8 ± 0,2 and 2.2 ± 0.2; 1.8 ± 0.1,respectively (p < 0.05).Conclusions. Our method of esophagogastric anastomosisis a safe, easy to implement and e?ective in preventing thedevelopment of re?ux after PGE for cancer of the upperthird of the stomach.