Abstract Nguyen Viet Hai

Clinical Outcomes of Laparoscopic Proximal Gastrectomy with Double-Flap Technique for Early Gastric Cancer in the Upper Third of the Stomach.

Hai Nguyen Viet, Long Vo Duy, Thong Dang Quang, Dat Tran Quang, Quoc Ho Le Minh, Anh Nguyen Vu Tuan, Bac Nguyen Hoang.

Upper Gastro-intestinal Surgery Department, University Medical Center, Hochiminh city, Vietnam

Background  Treatment for gastric cancer in the upper third of the stomach is difficult. Total gastrectomy has higher morbidity than proximal gastrectomy ( PG ). However PG is rarely used in Vietnam because of frequent postoperative reflux and uncommon diagnosis of early gastric cancer (GC). A double-flap esophagogastrostomy technique developed to prevent reflux after proximal gastrectomy was applied to laparoscopic proximal gastrectomy ( LPG ).

Methods This was a prospective, case-series with a total of 12 patients suffered from early gastric adenocarcinoma in the upper third of the stomach from April 2018 to May 2019, at University Medical Center, Hochiminh city, Vietnam. Of these patients, total cases underwent laparosopic proximal gastrectomy with double-flap esophagogastrostomy technique. Demographics, histological types of tumors, tumor diameters, operative time, intraoperative blood loss volume, number of  resected lymph nodes, postoperative complications  were studied to evaluate outcomes of this technique.

Results: The average operation time and estimated blood loss during LAPG using the double- flap technique was 300±15.8 min and 50.4±12.3 mL, respectively. None of the patients required conversion to open surgery, and no anastomosis leakage, no stenosis of the esophagogastric anastomosis as well as no postoperative reflux-esophagitis  occurred in this study. The mean number of resected lymph nodes was 22.7 ± 9.1. All resected margins were negative. The mean length of hospital stay was 6.7 ± 1.6 days. No mortality was observed.

Conclusion: Laparoscopic proximal gastrectomy with Double-Flap technique for early gastric cancer in the upper third of the stomach was a safe and feasible technique.