Open Access
American Research Journal of Medicine and Surgery
ISSN (Online): 2379-8955
DOI: 10.46568/arjms
A Single Center Study Comparing the Effects of Laparoscopic Proximal Gastrectomy and Laparoscopic Total Gastrectomy for Siewert types II /III Cancers
Abstract
Introduction: In recent years, the incidence of esophageal junction cancer (EGJ) has increased. The management of Siewert type II remains undecided while total gastrectomy with distal esophagectomy is mostly recommended for type III. Data is still lacking from studies assessing proximal and total gastrectomy approaches without thoracotomy as the surgical management of these types of cancer.
Methods: Data was retrospectively collected on histopathological characteristics, short-term complications, hemoglobin, total protein, albumin and weight changes. 18 patients with type II, 15 patient type III underwent proximal gastrectomy-Double tract reconstruction (PG-DTR) and 17 patients and 10 patients with type II and III respectively, underwent total gastrectomy-Roux-en y (TG-RY). Patients were followed up every 3 months for one year. The Spitzer-index was used to assess quality of life (QOL) at months 3,6 and 12.
Results: There was no statistical significance for operation time, length of hospital stay, blood loss, and change in weight at 6 months after surgery. Changes in hemoglobin, total protein and albumin also failed to show statistical significance (P=0.517, P=0.885 & P=0.8237, respectively). Recurrence was seen in 18.5% and 21.2% of TG and PG group respectively.QOL was significantly better in PG-DTR (P=0.017).
Conclusions: This study failed to show any difference for intraoperative and short-term complications between the two procedures. PG-DTR might provide better QOL for patients with types II/III cancer. In addition to D2, Siewert II/III tumors of larger sizes may require extended lymphadenectomy. This study needs further verification with larger cohort, additional parameters, and extended follow up periods.
Methods: Data was retrospectively collected on histopathological characteristics, short-term complications, hemoglobin, total protein, albumin and weight changes. 18 patients with type II, 15 patient type III underwent proximal gastrectomy-Double tract reconstruction (PG-DTR) and 17 patients and 10 patients with type II and III respectively, underwent total gastrectomy-Roux-en y (TG-RY). Patients were followed up every 3 months for one year. The Spitzer-index was used to assess quality of life (QOL) at months 3,6 and 12.
Results: There was no statistical significance for operation time, length of hospital stay, blood loss, and change in weight at 6 months after surgery. Changes in hemoglobin, total protein and albumin also failed to show statistical significance (P=0.517, P=0.885 & P=0.8237, respectively). Recurrence was seen in 18.5% and 21.2% of TG and PG group respectively.QOL was significantly better in PG-DTR (P=0.017).
Conclusions: This study failed to show any difference for intraoperative and short-term complications between the two procedures. PG-DTR might provide better QOL for patients with types II/III cancer. In addition to D2, Siewert II/III tumors of larger sizes may require extended lymphadenectomy. This study needs further verification with larger cohort, additional parameters, and extended follow up periods.
