Laparoscopic function-preserving surgery for early gastric cancer in the upper third of the stomach: Vagus-sparing proximal gastrectomy with side-to-side esophagogastric-tube anastomosis

Objective: Proximal gastrectomy with an anti-reflux procedure has been a treatment option for gastric cancer in the upper third of the stomach. For early gastric cancer, laparoscopic function-preserving gastrectomy with limited lymphadenectomy can be performed. Objective of this study was to develop a new surgical technique for gastric cancer in the upper third of the stomach. Methods: We present here our totally laparoscopic proximal gastrectomy with vagus-sparing lymphadenectomy and gastric-tube reconstruction. Six patients (five males and one female; mean age 74 years) with gastric cancer in the upper third of the stomach underwent the procedure. Detailed operative procedure and preliminary results were presented. Results: We have successfully performed the procedure with no conversion to open surgery. The mean operative time and blood loss were 413 minutes and 85 mL. No intraoperative and postoperative complications occurred except for reflux esophagitis in one patient. At the mean follow up of 25 months, all patients were alive without any sign of recurrence. Conclusion: Although long-term follow up and a larger number of patients are required to evaluate functional outcomes and oncological adequacy, our new technique provides a minimally invasive surgical option for early gastric cancer in the cardiac area.