J Korean Surg Soc.  2010 Aug;79(2):103-109. 10.4174/jkss.2010.79.2.103.

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

• Lee SH
• Seo KW
• Lee SH
• Yoon KY

• KMID: 2211979
• DOI: http://doi.org/10.4174/jkss.2010.79.2.103

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%.

Keyword

Gastric cancer; Laparoscopy assisted distal gastrectomy; Reconstructive procedure

MeSH Terms

Esophagogastric Junction
Gastrectomy
Gastroenterostomy
Humans
Laparoscopy
Retrospective Studies
Stomach Neoplasms

Figure

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  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.

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

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

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  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.

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