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Proximal Anterior-Antrum Posterior (PAAP) Overlapping Anastomosis in Minimally Invasive Pylorus-Preserving Gastrectomy for Early Gastric Cancer Located in the High Body and Posterior Wall of the Stomach

Journal of Gastric Cancer 2020년 20권 3호 p.277 ~ 289
박지현, 공성호, 최종호, Park Shin-Hoo, Suh Yun-Suhk, 박도중, 이혁준, 양한광,
소속 상세정보
박지현 ( Park Ji-Hyeon ) - Seoul National University Hospital Department of Surgery
공성호 ( Kong Seong-Ho ) - Seoul National University Hospital Department of Surgery
최종호 ( Choi Jong-Ho ) - Seoul National University Hospital Department of Surgery
 ( Park Shin-Hoo ) - Seoul National University Hospital Department of Surgery
 ( Suh Yun-Suhk ) - Seoul National University Hospital Department of Surgery
박도중 ( Park Do-Joong ) - Seoul National University Hospital Department of Surgery
이혁준 ( Lee Hyuk-Joon ) - Seoul National University Hospital Department of Surgery
양한광 ( Yang Han-Kwang ) - Seoul National University Hospital Department of Surgery

Abstract


Purpose: To evaluate the feasibility and safety of intracorporeal overlapping gastrogastrostomy between the proximal anterior wall and antrum posterior wall (PAAP; PAAP anastomosis) of the stomach in minimally invasive pylorus-preserving gastrectomy (PPG) for early gastric cancer (EGC).

Materials and Methods: From December 2016 to December 2019, 17 patients underwent minimally invasive PPG with PAAP anastomosis for EGC in the high body and posterior wall of the stomach. Intraoperative gastroscopy was performed with the rotation maneuver during proximal transection. A longer antral cuff (>4?5 cm) was created for PAAP than for conventional PPG (≤3 cm) at the point where a safe distal margin and good vascular perfusion were secured. Because the posterior wall of the proximal remnant stomach was insufficient for intracorporeal anastomosis, the anterior wall was used to create an overlapping anastomosis with the posterior wall of the remnant antrum. The surgical and oncological outcomes were analyzed, and the stomach volume was measured in patients who completed the 6-month follow-up. The results were compared to those after conventional PPG (n=11 each).

Results: PAAP anastomosis was successfully performed in 17 patients. The proximal and distal resection margins were 2.4±1.9 cm and 4.0±2.6 cm, respectively. No postoperative complications were observed during the 1-year follow-up esophagogastroduodenoscopy (n=10). The postoperative remnant stomach (n=11) was significantly larger with PAAP than with conventional PPG (225.6±118.3 vs. 99.1±63.2 mL; P=0.001). The stomach length from the anastomosis to the pylorus was 4.9±2.4 cm after PAAP.

Conclusions: PAAP anastomosis is a feasible alternative for intracorporeal anastomosis in minimally invasive PPG for highly posteriorly located EGC.

키워드

Stomach neoplasms; Laparoscopy; Surgical anastomosis; Minimally invasive surgical procedures; Volumetric CT

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