Reverse double-stapling end-to-end esophagogastrostomy in proximal gastrectomy

Area of Science:

• Surgical Oncology
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Proximal gastrectomy is a key surgical option for early gastric cancer located in the upper stomach.
• Standard techniques may involve gastrostomy wounds for stapler insertion.
• Evaluating novel methods to improve safety and outcomes is crucial.

Purpose of the Study:

• To introduce and evaluate a new double-stapling technique for proximal gastrectomy and esophagogastrostomy.
• To assess the safety and feasibility of this reverse double-stapling method.

Main Methods:

• Analysis of lymph node metastasis patterns in 53 patients with proximal early gastric cancer.
• Application of a reversed double-stapling technique in 15 patients undergoing proximal gastrectomy.
• Retrospective review of operative time, hospital stay, and complications.

Main Results:

• Proximal early gastric cancer exclusively metastasizes to lymph node stations 2, 3, and 7, which are removed during the procedure.
• The new method resulted in no gastrostomy wound in the remaining stomach.
• Median operation time was 156.5 minutes, with a median postoperative hospital stay of 8.0 days.
• Low complication rates: 2 wound complications and 2 cases of anastomosis site stricture treated successfully.

Conclusions:

• The 'reverse double-stapling method' is a fast, feasible, and safe technique for proximal gastrectomy.
• This technique avoids leaving a gastrostomy wound in the stomach remnant.
• It effectively addresses lymph node metastasis in proximal early gastric cancer.