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Li Li1,2, Lei Wang3, Jia-Li Yang4
1General Surgery, Cancer Center, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang 310014, China.
Abstract:
Proximal gastrectomy is more frequently recommended for early upper gastric cancer and Siewert II gastroesophageal junction cancer less than 4 cm in length. After proximal gastrectomy, the anatomical structure of the gastroesophageal junction can be destroyed, and the anti-reflux effect of the cardia is lost. In recent years, as various anti-reflux reconstructions have been developed, some functions of the stomach are retained, and serious reflux esophagitis is avoided after proximal gastrectomy. In this article, we summarized the indications, advantages, and disadvantages of various classic reconstruction and latest improved reconstruction method including esophageal and residual stomach anastomosis, tubular gastroesophageal anastomosis, muscle flap anastomosis, jejunal interposition, and double-tract reconstruction.
Insights
Proximal gastrectomy for upper gastric cancer can cause reflux. Various reconstruction methods are reviewed to retain stomach function and prevent esophagitis after this procedure.
Area of Science:
- Surgical Oncology
- Gastroenterology
Background:
- Proximal gastrectomy is indicated for early upper gastric cancer and Siewert II gastroesophageal junction cancer.
- This procedure can disrupt the gastroesophageal junction's anatomy and anti-reflux function.
Purpose of the Study:
- To review indications, advantages, and disadvantages of anti-reflux reconstructions after proximal gastrectomy.
- To discuss classic and novel reconstruction techniques.
Main Methods:
- Literature review of surgical reconstruction methods.
- Analysis of techniques including esophageal-gastric anastomosis, tubular esophagogastric anastomosis, muscle flap, jejunal interposition, and double-tract reconstruction.
Main Results:
- Various reconstruction methods aim to preserve gastric function and prevent reflux esophagitis.
- Different techniques offer distinct benefits and drawbacks for patients undergoing proximal gastrectomy.
Conclusions:
- Anti-reflux reconstructions are crucial for maintaining function after proximal gastrectomy.
- Advances in reconstruction techniques help mitigate complications like reflux esophagitis.
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