Feasibility and outcomes of laparoscopic proximal gastrectomy with Kamikawa double-flap reconstruction for upper – third gastric cancer

Abstract

Introduction: Laparoscopic Proximal Gastrectomy (LPG) is a priority selection for early cancer, submucosal tumor in the cardia location. However, the optimal method for reconstruction of intestinal circulation is still debated, especially regarding post-operative life quality. This study aimed to evaluate the feasibility, result and post-operativequality of life ofa  LPG with double-flap technique for reconstruction of digestive tract using Kamikawa technique – double flap (DFT).

Patients and method: A retrospective study was performed on 18 patients with early cancer, submucosal tumors in the 1/3 upper or cardia location undergoing LPG – DFT Kamikawa technique 5/2018 to 4/2022 at Digestive Surgery Department, University Medical Center, HCMC. We evaluated clinical data and operation results.

Results: Median age was 52 years. The operating time was 265 minutes, and the mean time to perform anastomosis was 85 minutes. There were 4 with early-stage adenocarcinoma, 10 patients with GIST, and 4 with leiomyoma. All cases were free of cancer cells in the surgical resection specimens. There were no intraoperative complications or postoperative complications. There was no postoperative mortality. The mean follow-up time was 20,3 months. Quality of life improved over time: the scores at 6, 12, and 24 months were: 25.7 ± 11.6, 21.3 ± 6.2, and 19.6 ± 3.9, respectively. The average hospital stay was 6,3 days.

Conclusions: LPG –DFT by Kamikawa technique is safe, feasible and patients quality of life were acceptable.

Keywords: Gastric cancer, proximal gastrectomy, double-flap reconstruction, Kamikawa

References

1. Hiki, S. Nunobe, T. Kubota, X. Jiang. Function-preserving gastrectomy for early gastric cancer. Ann Surg Oncol. 2013;20:2683-2692. 10.1245/s10434-013-2931-8
2. Kosuga, M. Tsujiura, S. Nakashima, M. Masuyama, E. Otsuji. Current status of function-preserving gastrectomy for gastric cancer. Ann Gastroenterol Surg. 2021;5:278-286. 10.1002/ags3.12430
3. W. Son, Y. J. Kim, G. A. Jeong, G. S. Cho, M. S. Lee. Long-Term Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Upper-Third Gastric Cancer. J Gastric Cancer. 2014;14:246-251. 10.5230/jgc.2014.14.4.246
4. K. Sun, Y. Y. Wu. Current status of laparoscopic proximal gastrectomy in proximal gastric cancer: Technical details and oncologic outcomes. Asian J Surg. 2021;44:54-58. 10.1016/j.asjsur.2020.09.006
5. Ueda, H. Shiroshita, T. Etoh, M. Inomata, N. Shiraishi. Laparoscopic proximal gastrectomy for early gastric cancer. Surg Today. 2017;47:538-547. 10.1007/s00595-016-1401-x
6. H. Kim, S. S. Park, J. Kim, Y. J. Boo, S. J. Kim, Y. J. Mok, et al. Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg. 2006;30:1870-1876; discussion 1877-1878. 10.1007/s00268-005-0703-8
7. Saze, K. Kase, H. Nakano, N. Yamauchi, A. Kaneta, Y. Watanabe, et al. Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer. BMC Surg. 2021;21:392. 10.1186/s12893-021-01390-1
8. Shaibu, Z. Chen, S. A. S. Mzee, A. Theophilus, I. A. Danbala. Effects of reconstruction techniques after proximal gastrectomy: a systematic review and meta-analysis. World J Surg Oncol. 2020;18:171. 10.1186/s12957-020-01936-2
9. Tsumura, S. Kuroda, M. Nishizaki, S. Kikuchi, Y. Kakiuchi, N. Takata, et al. Short-term and long-term comparisons of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy by the double-flap technique and laparoscopy-assisted total gastrectomy for proximal gastric cancer. PLoS One. 2020;15:e0242223. 10.1371/journal.pone.0242223
10. Yamashita, A. Yamamoto, Y. Tamamori, M. Yoshii, Y. Nishiguchi. Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy. Gastric Cancer. 2017;20:728-735. 10.1007/s10120-016-0674-5
11. Souya Nunobe, Masaru Hayami, Naoki Hiki. Morphological and functional reconstruction of the esophago-gastric junction with a double-flap technique after laparoscopic proximal gastrectomy. Annals of Laparoscopic and Endoscopic Surgery. 2017;2:25-25. 10.21037/ales.2017.02.01
12. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24:1-21. 10.1007/s10120-020-01042-y
13. R. Lundell, J. Dent, J. R. Bennett, A. L. Blum, D. Armstrong, J. P. Galmiche, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172-180. 10.1136/gut.45.2.172
14. C. Huang, C. N. Yeh, M. Y. Chen, S. Y. Wang, K. H. Liu, C. Y. Tsai, et al. Surgical options for submucosal tumors near the esophagogastric junction: does size or location matter? BMC Surg. 2020;20:179. 10.1186/s12893-020-00840-6
15. Nakamura, H. Yamaue. Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014. Surg Today. 2016;46:517-527. 10.1007/s00595-015-1185-4
16. Xu, Y. Tan, Y. Wang, C. Xi, N. Ye, X. Xu. Proximal versus total gastrectomy for proximal early gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98:e15663. 10.1097/md.0000000000015663
17. H. Ahn, D. H. Jung, S. Y. Son, C. M. Lee, D. J. Park, H. H. Kim. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer. 2014;17:562-570. 10.1007/s10120-013-0303-5
18. Muraoka, M. Kobayashi, Y. Kokudo. Laparoscopy-Assisted Proximal Gastrectomy with the Hinged Double Flap Method. World J Surg. 2016;40:2419-2424. 10.1007/s00268-016-3510-5
19. Shoji, S. Nunobe, S. Ida, K. Kumagai, M. Ohashi, T. Sano, et al. Surgical outcomes and risk assessment for anastomotic complications after laparoscopic proximal gastrectomy with double-flap technique for upper-third gastric cancer. Gastric Cancer. 2019;22:1036-1043. 10.1007/s10120-019-00940-0
20. Hayami, N. Hiki, S. Nunobe, S. Mine, M. Ohashi, K. Kumagai, et al. Clinical Outcomes and Evaluation of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach. Ann Surg Oncol. 2017;24:1635-1642. 10.1245/s10434-017-5782-x
21. Kuroda, Y. Choda, S. Otsuka, S. Ueyama, N. Tanaka, A. Muraoka, et al. Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study). Ann Gastroenterol Surg. 2019;3:96-103. 10.1002/ags3.12216