Evaluation of Postoperative Quality of Life of Proximal Gastrectomy Preserving Anti-reflux Function in Lower Esophagus for Gastric Tumor

Hideki Tsuji, Shigemitsu Ando* and Akira Mitsui

Department of Surgery, Toyota Memorial Hospital
Department of Gynecology, Kikuchi Hospital*

Background: The function of the lower esophagus sphincter (LES) is closely related to the length of the esophagus exposed to the positive environmental pressure of the abdomen. Anti-reflux function is preserved postoperatively by maintaining the preoperative length of the intraabdominal esophageal segment. Subjects and Method: Proximal gastrectomy was indicated for early gastric cancer and MP cancer with NO and gastrointestinal stromal tumor located in the upper third of the stomach. Subjects were 21 patients who had undergone proximal gastrectomy at least one year earlier. Reconstructive procedures were esophagogastrostomy (EG group, n=15) and jejunal pouch interposition in those patient whose remnant stomach was less than two-thirds (JPI group, n=6). The preoperative length of the intraabdominal esophageal segment was maintained postoperatively by anchoring the posterior wall of the anastomotic stoma to the median arcuate ligament (MAL) with 3 sutures following proximal gastrectomy. Patient QOL was evaluated by symptoms and changes in body weight. Results: Reflux symptoms were observed in 2 patients (13.3%) in the EG group, but none in the JPI group. In one of 2 patients who had reflux symptoms MAL fixing failed and in another one remnant stomach was less than two-thirds. The postoperative length of the intraabdominal esophageal segment in barium meal studies was from 1.0 to 3.0 cm (2.0 cm on the average) except for one patient who suffered reflux. Postoperative levels of the anastomotic stoma (circular staple) in contrast to vertebra showed almost no difference from preoperative levels of the esophagogastric junction except for the patient suffering reflux, presumably because MAL fixing failed. Endoscopy was done in 16 patients, who showed no evidence of esophagitis except for the one above exception. No significant difference was seen in pre- and postoperative intra luminal pressure of LES in 5 patients (P=0.4). The post-/preoperative ratio of body weight was 92.0±5% in the EG group and 84.3±7% in the JPI group. Conclusions: This easy, simple procedure preserves postoperative QOL well by preventing complications such as reflux esophagitis. Esophagogastrostomy is indicated for resection of less than one-third of the stomach.

Key words
proximal gastrectomy, gastroesophageal reflux, reflux esophagitis, gastric tumor

Reprint requests
Hideki Tsuji Department of Surgery, Toyota Memorial Hospital
1-1 Heiwa-cho, Toyota, 471-8513 JAPAN

Accepted
November 30, 2004

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