DOI: https://doi.org/10.21203/rs.3.rs-194845/v1
Objective: Proximal gastrectomy was acted as a function-preserving operation for upper third gastric cancer. The aim of this study is to compare the surgical short-term outcomes between proximal gastrectomy with gastric tube reconstruction and proximal gastrectomy with Jejunal interposition reconstruction in the upper third gastric cancer.
Methods: A retrospective review of 301 patients who underwent proximal gastrectomy with jejunal interposition (JI) or gastric tube (GT) at the Harbin Medical University Cancer Hospital between June 2007 and December 2016 was performed. The Gastrointestinal Symptom Rating Scale (GSRS) and Visick grade were used to evaluate the post-gastrectomy syndromes. The gastrointestinal fiberoscopy was used to evaluate the prevalence and severity of reflux esophagitis by Los Angeles (LA) classification system.
Results: The JI group had a longer operation time than GT group (220±52 vs 182±50 min), whereas there was no significant difference in blood loss. Compared to the GT group, the Visick grade and GSRS score were significantly higher than that of the JI group. The reflux esophagitis of GT group was significantly higher than that of the JI group.
Conclusion: Proximal gastrectomy is well tolerated, with excellent short-outcomes in patients with upper third gastric cancer . C ompared with GT construction, JI construction has clear functional advantages and may provide better quality of life for patients with upper third gastric cancer.
Table 1 Clinicopathological characteristics of patients who underwent JI or GT reconstruction
|
Parameters |
Total |
JI group |
GT group |
P value |
|
Cases (n) |
301 |
150 |
151 |
|
|
Age (years) |
0.032 |
|||
|
＜60 |
136 |
77 |
59 |
|
|
≥60 |
165 |
73 |
92 |
|
|
Gender |
0.791 |
|||
|
Male |
243 |
122 |
121 |
|
|
Female |
58 |
28 |
30 |
|
|
Height (cm) |
170±7 |
171±6 |
168±7 |
＜0.001** |
|
Weight (Kg) |
68±11 |
67±10 |
68±12 |
0.433 |
|
BMI |
23.66±3.75 |
23.28±3.95 |
24.04±3.50 |
0.078 |
|
Hospital stay (day) |
23±3 |
21±1 |
25±5 |
＜0.001** |
|
Operating time (min) |
201±54 |
220±52 |
182±50 |
＜0.001** |
|
Blood loss (ml) |
162±95 |
169±84 |
155±104 |
0.200 |
|
Tumor size (cm) |
0.778 |
|||
|
＜5 |
179 |
88 |
91 |
|
|
≥5 |
122 |
62 |
60 |
|
|
ABO blood type |
0.745 |
|||
|
A |
78 |
44 |
34 |
|
|
B |
105 |
51 |
54 |
|
|
O |
91 |
42 |
49 |
|
|
AB |
27 |
13 |
14 |
|
|
Pathological TNM classification |
||||
|
T stage |
＜0.001** |
|||
|
T1 |
34 |
14 |
20 |
|
|
T2 |
46 |
21 |
25 |
|
|
T3 |
96 |
28 |
68 |
|
|
T4 |
125 |
87 |
38 |
|
|
N stage |
＜0.05* |
|||
|
N0 |
141 |
69 |
72 |
|
|
N1 |
64 |
26 |
38 |
|
|
N2 |
57 |
38 |
19 |
|
|
N3 |
39 |
17 |
22 |
|
|
TNM stage |
0.093 |
|||
|
I |
65 |
27 |
38 |
|
|
II |
119 |
56 |
63 |
|
|
III |
117 |
67 |
50 |
|
|
Lauren Classification |
0.144 |
|||
|
Diffuse type |
18 |
5 |
13 |
|
|
Intestinal type |
208 |
108 |
100 |
|
|
Mixed type |
75 |
37 |
38 |
|
|
Differentiation |
＜0.05* |
|||
|
poorly differentiated |
126 |
73 |
53 |
|
|
moderately differentiated |
143 |
65 |
78 |
|
|
well differentiated |
32 |
12 |
20 |
|
|
Vessel invasion |
0.867 |
|||
|
positive |
166 |
82 |
84 |
|
|
negative |
135 |
68 |
67 |
|
|
Nerve invasion |
0.001* |
|||
|
positive |
204 |
115 |
89 |
|
|
negative |
97 |
35 |
62 |
|
|
Pathology |
＜0.001** |
|||
|
adenocarcinoma |
211 |
119 |
92 |
|
|
mucinous carcinoma |
62 |
15 |
47 |
|
|
signet ring cell carcinoma |
18 |
12 |
6 |
|
|
others |
10 |
4 |
6 |
|
|
Total lymph nodes |
＜0.001** |
|||
|
＜20 |
168 |
109 |
59 |
|
|
≥20 |
133 |
41 |
92 |
|
|
Positive lymph nodes |
＜0.001** |
|||
|
＜3 |
154 |
95 |
59 |
|
|
≥3 |
147 |
55 |
92 |
*:P<0.05; **: P<0.001
Table 2 Postoperative functional outcomes
|
Parameters |
Total |
JI group |
GT group |
P value |
|
Cases (n) |
301 |
150 |
151 |
|
|
Visick grade |
<0.05* |
|||
|
V1 |
201 |
112 |
89 |
|
|
V2 |
71 |
29 |
42 |
|
|
V3 |
19 |
7 |
12 |
|
|
V4 |
10 |
2 |
8 |
|
|
GSRS score |
26.89±5.06 |
25.58±4.56 |
28.48±5.78 |
＜0.001** |
*:P<0.05; **: P<0.001
Table 3 Comparison of preoperative and postoperative nutritional outcomes between groups
|
Parameters |
Total |
JI group |
GT group |
P value |
|
Cases (n) |
301 |
150 |
151 |
|
|
Preoperative |
||||
|
Total protein (g/l) |
68.62±7.92 |
68.23±6.37 |
69.00±9.20 |
0.399 |
|
Albumin (g/l) |
42.44±4.57 |
43.63±4.65 |
41.25±4.18 |
＜0.001** |
|
Globulin (g/l) |
26.04±5.02 |
24.62±5.38 |
27.44±4.20 |
＜0.001** |
|
Prealbumin (g/l) |
254.68±66.74 |
252.91±67.49 |
256.44±66.17 |
0.647 |
|
White blood cell (W) |
6.62±2.07 |
6.38±2.05 |
6.86±2.07 |
0.044* |
|
Neutrophils (N) |
3.89±1.61 |
3.67±1.36 |
4.12±1.80 |
0.015* |
|
Lymphocyte (L) |
2.01±0.69 |
1.98±0.66 |
2.04±0.72 |
0.452 |
|
Monocyte (M) |
0.49±0.20 |
0.45±0.20 |
0.52±0.20 |
0.003* |
|
Hemoglobin (Hb) |
133.01±23.44 |
132.81±21.71 |
133.22±25.11 |
0.880 |
|
Erythrocyte (E) |
4.41±0.59 |
4.39±0.55 |
4.44±0.63 |
0.464 |
|
Platelet (P) |
239.54±75.45 |
250.79±82.61 |
228.36±65.98 |
0.010* |
|
Postoperative |
||||
|
Total protein (g/l) |
54.44±5.72 |
53.64±6.13 |
55.23±5.19 |
0.016 |
|
Albumin (g/l) |
32.57±4.08 |
33.11±4.55 |
32.02±3.48 |
0.020 |
|
Globulin (g/l) |
21.79±4.56 |
20.53±5.22 |
23.04±3.38 |
＜0.001** |
|
Prealbumin (g/l) |
172.06±44.29 |
170.63±44.76 |
173.49±43.92 |
0.576 |
|
White blood cell (W) |
11.75±3.65 |
11.61±3.87 |
11.90±3.42 |
0.491 |
|
Neutrophils (N) |
8.07±3.82 |
5.87±3.03 |
10.26±3.23 |
＜0.001** |
|
Lymphocyte (L) |
0.95±0.45 |
1.03±0.50 |
0.87±0.37 |
0.002** |
|
Monocyte (M) |
0.67±0.28 |
0.65±0.28 |
0.70±0.28 |
0.122 |
|
Hemoglobin (Hb) |
122.47±16.42 |
122.32±17.08 |
122.63±15.79 |
0.870 |
|
Erythrocyte (E) |
4.07±0.51 |
4.07±0.53 |
4.07±0.50 |
0.866 |
|
Platelet (P) |
203.61±67.51 |
212.42±75.00 |
194.80±58.00 |
0.023* |
*:P<0.05; **: P<0.001
Table 4 Endoscopic findings of the JI and GT group
|
Parameters |
Total |
JI group |
GT group |
P value |
|
Cases (n) |
301 |
150 |
151 |
|
|
Los Angeles classification |
31 |
48 |
0.028 |
|
|
A |
20 |
30 |
||
|
B |
8 |
13 |
||
|
C |
3 |
5 |
||
|
D |
0 |
0 |
*:P<0.05;