Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2010 Aug;79(2):103-109. Korean.
    Published online Aug 02, 2010.
    https://doi.org/10.4174/jkss.2010.79.2.103
    Copyright © 2010 The Korean Surgical Society
    Original Article

    Prediction of Reconstructive Procedure after Laparoscopy Assisted Distal Gastrectomy in Patients with Distal Early Gastric Cancer

    Seung Hun Lee, M.D., Kyung Won Seo, M.D., Sang Ho Lee, M.D. and Ki Young Yoon, M.D.
      • Department of Surgery, Gospel Hospital, College of Medicine, Kosin University, Busan, Korea.
    • Corresponding author (Email: yoonkiyoung@naver.com )
    Received March 02, 2010; Accepted April 05, 2010.

    Abstract

    Purpose

    Laparoscopy assisted distal gastrectomy (LADG) has been accepted as the best standard operative technique in early gastric cancer. But, no predictive indicators of reconstructive procedure were reported. Analyzing the reconstructive procedure after LADG according to location of the lesion, we, herein, suggest an alternative.

    Methods

    From May 2008 to May 2009, 55 patients with distal gastric cancer who underwent LADG were examined retrospectively. The group of 55 patients were assigned to two groups according to the reconstructive procedure undertaken: 41, Billroth I (BI); 14, Billroth II (BII). After measuring the distance between esophagogastric junction and tumor (ET) and between pyloric ring and tumor (PT), we found ET/(ET+PT).

    Results

    The mean±standard error time of ET in BI and BII group was 20.5±7.9 cm (5~38) and 13.9±6.7 cm (6~30). The mean±standard error time of PT in BI and BII group was 15.1±8.2 cm (2~36) and 22.6±9.1 cm (8~40). The mean±standard error time of ET/(ET+PT) in BI and BII group was 57.0±21.1% (16.1~95.0) and 39.1±19.0% (13.0~75.0). ET, PT and ET/(ET+PT) were correlated with reconstructive procedure (P=0.007, 0.006, 0.005). In comparative analysis of correlation between ET and reconstructive procedure, 95% confidence level in BI and BII group is 18.0~22.9 cm and 10.0~17.7 cm; between PT and reconstructive procedure, 12.5~17.7 cm and 17.4~27.8 cm; and between ET/(ET+PT) and reconstructive procedure, 51.1~64.4% and 28.1~50.0%.

    Conclusion

    In our study, predictive indicators of decision for reconstructive procedure in ET, PT, ET/(ET+PT) is 17.8~18.0 cm, 17.4~17.7 cm, 50.0~51.1%.

    Keywords
    Gastric cancer; Laparoscopy assisted distal gastrectomy; Reconstructive procedure

    Figures

    Fig. 1
    (A) Endoscopic clipping at proximal and distal margin of the lesion. (B) Endoscopic tattooing on submucosa of the lesion. (C) X-ray finding after endoscopic clipping.

    Fig. 2
    Relation between distance of the tumor from the esophagogastric junction (ET) and reconstructive procedure.

    Fig. 3
    Relation between distance of the tumor from the pylorus (PT) and reconstructive procedure.

    Fig. 4
    Relation between the proportion of distance of the tumor from esophagogastric junction (ET) to total length of the stomach (ET+PT) and reconstructive procedure.

    Tables

    Table 1
    Comparison of clinical characteristics between B I and B II reconstruction group

    Table 2
    Comparison of location of lesion between B I and B II reconstruction group

    References

      1. Park CH, Song KY, Kim SN. Treatment results for gastric cancer surgery: 12 years' experience at a single institute in Korea. Eur J Surg Oncol 2008;34:36–41.
      1. Korea Gastric Cancer Association. Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 2002;2:105–114.
      1. The Information Committee of the Korean Gastric Cancer Association. 2004 Nationwide gastric cancer report in Korea. J Korean Gastric Cancer Assoc 2007;7:47–54.
      1. Sowa M, Kato Y, Nishimura M, Kubo T, Maekawa H, Umeyama K. Surgical approach to early gastric cancer with lymph node metastasis. World J Surg 1989;13:630–636.
      1. Kim JP, Hur YS, Yang HK. Lymph node metastasis as a significant prognostic factor in early gastric cancer: analysis of 1,136 early gastric cancers. Ann Surg Oncol 1995;2:308–313.
      1. Hyung WJ, Cheong JH, Kim J, Chen J, Choi SH, Noh SH. Analyses of prognostic factors and gastric cancer specific survival rate in early gastric cancer patients and its clinical implication. J Korean Surg Soc 2003;65:309–315.
      1. Lim KH, Chung HY, Yu W. Prognosis of early gastric cancer: impact of lymph node metastasis. J Korean Surg Soc 2003;65:18–22.
      1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 1994;4:146–148.
      1. Japan Society for Endoscopic Surgery. Nationwide survey on endoscopic surgery in Japan. J Jpn Soc Endosc Surg 2004;9:475–563.
      1. Kim HH, Kim KH, Kim DH, Kim C, Kim BS, Kim YW, et al. Korean Laparoscopic Gastrointestinal Surgery Study Group. Nationwide survey of laparoscopic gastric surgery in Korea, 2004. J Korean Gastric Cancer Assoc 2005;5:295–303.
      1. Song KY. The current status and future perspectives of laparoscopic surgery for gastric cancer. Korean J Gastroenterol 2007;50:233–241.
      1. Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S. Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 2000;135:806–810.
      1. Song KY, Kim SN, Park CH. Laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for gastric cancer: technical and oncologic aspects. Surg Endosc 2008;22:655–659.
      1. Ko YJ, Choi SY, Kim CS. A clinical review of laparoscopic surgery in duodenal ulcer. J Korean Surg Soc 1995;48:494–501.
      1. Kim EK, Lee IK, Kim WW, Chun SW, Kim SN, Song YT. Laparoscopic resection of benign gastric tumor. J Korean Soc Endosc Laparosc Surg 1998;1:5–11.
      1. Jeong HS, Kim KJ, Cha YJ, Kim SP, Kim GC, Jang JH, et al. Comparison of the early postoperative results after a Billroth I and a Billroth II gastrectomy for gastric cancer. J Korean Gastric Cancer Assoc 2002;2:96–100.
      1. Kyzer S, Binyamini Y, Melki Y, Ohana G, Koren R, Chaimoff C, et al. Comparative study of the early postoperative course and complications in patients undergoing Billroth I and Billroth II gastrectomy. World J Surg 1997;21:763–767.
      1. Kojima K, Yamada H, Inokuchi M, Kawano T, Sugihara K. A comparison of Roux-en-Y and Billroth-I reconstruction after laparoscopy-assisted distal gasrectomy. Ann Surg 2008;247:962–967.
      1. Kim MH, Yoo CH, Sohn CI, Park DI, Jeon WK. Comparative study of duodenogastric reflux according to reconstructive procedure after distal subtotal gastrectomy. J Korean Surg Soc 2006;71:256–261.
      1. Kim SG, Kim YK, Heo YJ, Song KY, Kim JJ, Jin HM, et al. Comparison of the results in gastric carcinoma patients undergoing Billroth I and Billroth II gastrectomiesy. J Korean Gastric Cancer Assoc 2007;7:16–22.
      1. Ishikawa M, Kitayama J, Kaizaki S, Nakayama H, Ishigami H, Fujii S, et al. Prospective randomized trial comparing Billroth I and Roux-en-Y procedures after distal gastrectomy for gastric carcinoma. World J Surg 2005;29:1415–1421.
      1. Fukuhara K, Osugi H, Takada N, Takemura M, Higashino M, Kinoshita H. Reconstructive procedure after distal gastrectomy for gastric cancer that best prevents duodenogastroesophageal reflux. World J Surg 2002;26:1452–1457.
      1. Csendes A, Burgos AM, Smok G, Burdiles P, Braghetto I, Diaz JC. Latest results (12-21 years) of a prospective randomized study comparing Billroth II and Roux-en-Y anastomosis after a partial gastrectomy plus vagotomy in patients with duodenal ulcers. Ann Surg 2009;249:189–194.
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    MeSH Terms
    Esophagogastric Junction
    Gastrectomy
    Gastroenterostomy
    Humans
    Laparoscopy
    Retrospective Studies
    Stomach Neoplasms
    Metrics
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