Randomized Clinical Trial
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World J Gastroenterol. Jul 7, 2014; 20(25): 8268-8273
Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8268
Proximal gastrectomy with jejunal interposition and TGRY anastomosis for proximal gastric cancer
Ping Zhao, Shuo-Meng Xiao, Ling-Chao Tang, Zhi Ding, Xiang Zhou, Xiao-Dong Chen
Ping Zhao, Shuo-Meng Xiao, Ling-Chao Tang, Zhi Ding, Xiang Zhou, Xiao-Dong Chen, Department of Gastro-hepatic Surgery, Sichuan Cancer Hospital, Chengdu 610041, Sichuan Province, China
Author contributions: Zhao P, Xiao SM and Tang LC designed the study and wrote the manuscript; Ding Z, Zhou X and Chen XD collected and analyzed the data.
Correspondence to: Dr. Shuo-Meng Xiao, Department of Gastro-hepatic Surgery, Sichuan Cancer Hospital, No. 55, South 4th Section, Renmin Road, Chengdu 610041, Sichuan Province, China. xiaoshuomeng2010@163.com
Telephone: +86-28-85420845 Fax: +86-28-85420845
Received: November 2, 2013
Revised: March 9, 2014
Accepted: April 5, 2014
Published online: July 7, 2014
Abstract

AIM: To compare the short-term outcomes of patients who underwent proximal gastrectomy with jejunal interposition (PGJI) with those undergoing total gastrectomy with Roux-en-Y anastomosis (TGRY).

METHODS: From January 2009 to January 2011, thirty-five patients underwent PGJI, and forty-one patients underwent TGRY. The surgical efficacy and short-term follow-up outcomes were compared between the two groups.

RESULTS: There were no differences in the demographic and clinicopathological characteristics. The mean operation duration and postoperative hospital stay in the PGJI group were statistically longer than those in the TGRY group (P = 0.00). No anastomosis leakage was observed in two groups. No statistically significant difference was found in endoscopic findings, Visick grade or serum albumin level. The single-meal food intake in the PGJI group was more than that in the TGRY group (P = 0.00). The PG group showed significantly better hemoglobin levels in the second year (P = 0.02). The two-year survival rate was not significantly different (PGJI vs TGRY, 93.55% vs 92.5%, P = 1.0).

CONCLUSION: PGJI is a safe, radical surgical method for proximal gastric cancer and leads to better outcomes in terms of the single-meal food intake and hemoglobin level, compared with TGRY in the short term.

Keywords: Proximal gastric cancer, Proximalgastrectomy with jejunal interposition, Total gastrectomy with Roux-en-Y anastomosis

Core tip: For proximal gastric cancer, total gastrectomy is widely accepted because of the lower incidence of reflux esophagitis. However, the continuity of the digestive tract, food storage and nutritional status should be considered after radical surgery for proximal gastric cancer. We conducted this study to compare proximal gastrectomy with jejunal interposition (PGJI) and total gastrectomy with Roux-en-Y anastomosis (TGRY) for proximal gastric cancer. Based on our two-year follow-up, the single-meal food intake in the PGJI group was more than that in the TGRY group, and the hemoglobin level was well maintained in the PGJI group. The two-year survival rate was not significantly different.