Postoperative reflux esophagitis in laparoscopic distal gastrectomy with Billroth-I reconstruction for gastric cancer: Nutritional effect and preoperative risk factors

Effect of forearm and posterior wall anastomosis on gastroesophageal reflux in proximal gastrectomy patients

BACKGROUND

Proximal gastrectomy for gastric cancer often leads to postoperative gastroesophageal reflux (GER). This study compares the impact of forearm anastomosis and posterior wall anastomosis techniques on GER in patients undergoing this procedure.

AIM

To identify the most effective method for reducing reflux symptoms while preserving gastrointestinal integrity and nutritional status.

METHODS

A retrospective evaluation was conducted on 60 patients who underwent proximal gastrectomy between December 2020 and December 2023, divided equally into two groups based on the anastomosis technique used (forearm or posterior wall). GER symptoms were assessed using the GER disease questionnaire (GerdQ) preoperatively and on the first postoperative day. Biochemical markers [diamine oxidase (DAO), D-lactic acid, and endotoxin (ETX)] and nutritional indicators [serum ferritin (SF), prealbumin (PA), and albumin (ALB)] were measured to evaluate gastrointestinal barrier function and nutritional status.

RESULTS

Both groups showed significant improvements in GerdQ scores and reflux symptom scores post-treatment, with the observation group exhibiting greater reductions. Biochemical markers indicated enhanced gastrointestinal barrier function post-treatment in both groups, with notable increases in DAO, D-lactic, and ETX levels. Nutritional status indicators also demonstrated significant changes, with reductions in SF, PA, and ALB levels, suggesting an impact of treatment on inflammatory and nutritional status.

CONCLUSION

The forearm anastomosis technique appears to be more effective in reducing GER symptoms and preserving gastrointestinal health in patients undergoing proximal gastrectomy for gastric cancer compared to the posterior wall anastomosis technique. These preliminary findings advocate for further research to confirm the benefits and potentially standardize Forearm Anastomosis in surgical practice for gastric cancer.

Risk factors for death from other diseases after curative gastrectomy and lymph node dissection for gastric cancer

BACKGROUND

Recent advances in treatment are expected to bring a cure to more patients with gastric cancer (GC). Focusing on the risk of death from other diseases (DOD) has become a crucial issue in patients cured of GC. The aim of this study was to elucidate the risk factors for DOD in patients who underwent curative gastrectomy with lymph node dissection for GC.

METHODS

We enrolled 810 patients who underwent curative gastrectomy with lymph node dissection for GC from January 1990 to December 2014 and had no recurrence or death of GC until December 2019. We investigated the risk factors for DOD defined as death excluding death from a malignant neoplasm, accident, or suicide after gastrectomy, focusing on the perioperative characteristics at gastrectomy.

RESULTS

Among 315 deaths from any cause, 210 died from diseases other than malignancy, accidents and suicide. The leading cause of DOD was pneumonia in 54 patients (25.7%). The actual survival period in 167 patients (79.5%) with DOD was shorter than their estimated life expectancy at gastrectomy. Multivariate analysis revealed that a high Charlson Comorbidity Index score (score 1-2: hazard ratio [HR] 2.192, 95% confidence interval [CI] 1.713-2.804, P < 0.001 and score ≥ 3: HR 4.813, 95% CI 3.022-7.668, P < 0.001), total gastrectomy (HR 1.620, 95% CI 1.195-2.197, P = 0.002) and the presence of postoperative complications (HR 1.402, 95% CI 1.024-1.919, P = 0.035) were significant independent risk factors for DOD after gastrectomy for GC, in addition to age of 70 years or higher, performance status of one or higher and body mass index less than 22.0 at gastrectomy.

CONCLUSIONS

Pneumonia is a leading cause of DOD after curative gastrectomy and lymph node dissection for GC. Paying attention to comorbidities, minimizing the choice of total gastrectomy and avoiding postoperative complications are essential to maintain the long-term prognosis after gastrectomy.