Laparoscopic proximal gastrectomy for upper third early gastric cancer
Laparoscopic proximal gastrectomy is theoretically superior to total gastrectomy in the treatment of upper third early gastric cancer, as the former is less invasive and better preserves function. Three major issues have limited the more widespread use of proximal gastrectomy: its oncologic safety, functional benefits, and risk of reflux esophagitis. Many recent studies suggest that the oncologic safety of laparoscopic proximal and total gastrectomy is similar, with proximal gastrectomy resulting in improved functional outcomes. To date, however, no standard reconstruction method has been developed to effectively prevent reflux esophagitis after proximal gastrectomy. Our recent retrospective study found that no patient who underwent laparoscopic proximal gastrectomy with double tract reconstruction experienced severe reflux esophagitis and that this method was superior to laparoscopic total gastrectomy in preventing anemia and vitamin B12 deficiency. This result led to the design of a randomized controlled trial, the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) 05 (ClinicalTrials.gov; identifier: NCT02892643), which is currently comparing laparoscopic proximal gastrectomy with double tract reconstruction with laparoscopic total gastrectomy. This trial may help surgeons choose the optimal surgical approach and strategy for patients with proximal early gastric cancer.