A modified double-tract reconstruction following laparoscopic proximal gastrectomy for Siewert Ⅱ adenocarcinoma of the esophagogastric junction (with video)

Abstract

Objective: The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. For patients with resectable Siewert Ⅱ AEG, there is still a lack of consensus with regards to which surgical procedure can well balance survival time and quality of life. This study aims to describe a modified double-tract reconstruction (DTR) method following laparoscopic proximal gastrectomy (LPG) and to evaluate the feasibility, safety, and effects of this novel method. Method: This study retrospectively reviewed 29 patients who received modified DTR after LPG for Siewert Ⅱ AEG at a single center between August 2015 and October 2020. Clinicopathological characteristics, surgical outcomes, nutritional status and dietary ability were analyzed. Result: The mean surgical time was 206.4 ± 39.2 min, mean intraoperative blood loss was 175.9 ± 41.4 mL, and median postoperative hospital stay was 11 d (range, 9–70 d). The early complication rate was 13.8% (n = 4), and the late complication rate was 6.9% (n = 2). No reflux esophagitis or reflux symptom was recorded. There were no perioperative deaths within three months post-operatively. At the third follow-up month after surgery, most patients (25/29, 86.2%) were experiencing sufficient oral food intake, with a median frequency of 5 meal/d (range, 3–6 meal/d). The median total weight loss was 8 kg (range, 0–15 kg) and there were no case of post-operative malnutrition. Conclusion: The modified DTR method following LPG represents a novel, safe, and feasible method that provides sufficient nutritional support with few diet-related discomforts. Prospective large-scale randomized trials are now needed to validate the clinical applicability of this method.

Keywords

• Adenocarcinoma
• Esophagogastric junction
• Double-tract reconstruction
• Laparoscopic proximal gastrectomy