A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study

BackgroundTotal gastrectomy has been performed for adenocarcinoma of the esophagogastric junction (AEG) because of severe gastro-esophageal reflux (GER) after classic esophago-gastrostomy. Thus, we applied a novel esophago-gastrostomy with anti-reflux triangle-valve (EGAT) in Siewert type II/III AEG patients to prevent postoperative GER.MethodsThis was a three-year retrospective cohort study. We followed 144 Siewert type II/III AEG patients who underwent EGAT (n = 73) and total gastrectomy (TG, n = 71) at our hospital. We analyzed the incidence of postoperative nutritional (hemoglobin, protein levels, and weight) and reflux esophagitis in the two groups. Finally, we conducted a survival analysis was performed.ResultsThe average operation time was significantly lower in the EGAT group than in the TG group. However, no significant differences were detected for postoperative complications between the two groups. Postoperative nutritional indexes, including albumin and prealbumin, were significantly higher in the EGAT group than in the TG group six months after surgery. Moreover, we evaluated the hemoglobin one year after surgery, and total protein and body weight after two years of surgery were significantly higher in the EGAT group compared to the TG group. Further, the reflux esophagitis follow-up did not differ (p > 0.05). Finally, no significant difference was detected in the 3-year overall survival rate between the two groups of patients (p = 0.519).ConclusionEGAT is simple and can prevent GER in Siewert type II/III AEG patients.

Automated summary

This study applied a novel esophago-gastrostomy with anti-reflux triangle-valve (EGAT) in Siewert type II/III adenocarcinoma of the esophagogastric junction (AEG) patients to prevent postoperative gastro-esophageal reflux (GER). The results showed that EGAT had advantages in terms of shorter operation time, better nutritional indexes, and lower incidence of reflux esophagitis compared to total gastrectomy (TG). Furthermore, there was no significant difference in the 3-year overall survival rate between the EGAT and TG groups.