Reconstruction following proximal gastrectomy

E. Strong (ed.). Gastric cancer. Principles and practice. Springer (2015)


Proximal resections (Fig. 12.1b) have seen a revival in recent years due to the high number of early gastric cancers in Asian countries that demand a more limited resection than total gastrectomy due to their low frequency of lymph node metastasis [16]. Reconstruction after proximal gastrectomy was initially performed as a direct esophago-gastrostomy, but this procedure comes along with a high rate of gastric reflux [17]. To prevent the occurrence of gastric reflux, different approaches have been tested, including combining a esophago-gastrostomy with a fundoplication [18], jejunal interposition with and without pouch [19, 20], double tract reconstruction [21], and ileo-colic interposition [22]. To date, only a few nonrecurrent RCTs have been performed, often reporting on few patients only [18–21]. Of note, two RCTs have been published on the topic of including a pouch or not: both favor a pouch when performing a jejunal interposition [19, 20]. With proximal resections becoming the standard operation for early proximal gastric cancers at least in Asia, more RCTs analyzing different reconstruction methods are expected to be conducted within the next years. Currently, no evidencebased advice can be given upon which procedure to favor.

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