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[Proximal gastrectomy. ±ÙÀ§ À§ÀýÁ¦¼ú] - ðû

1. Proximal gastrectomy with esophago-jejunostomy ÀαⰡ ½ÄÀº ÀÌÀ¯

2. Proximal gastrectomy with double tract recontstruction (DTR)

3. Cases

4. FAQs

5. References


1. Proximal gastrectomy with esophago-jejunostomy ÀαⰡ ½ÄÀº ÀÌÀ¯

Á¦°¡ 2004³â óÀ½ ºÎ±³¼ö ¹ß·ÉÀ» ¹Þ¾ÒÀ» ¹«·Æ¿¡´Â °£È¤ proximal gastrectomy with EG-stomy°¡ ½ÃÇàµÇ¾ú½À´Ï´Ù. ¼ú±â°¡ °£´ÜÇÏ¿© ¿Ü°ú Àǻ翡°Ô´Â ½¬¿î ¼ö¼úÀ̸鼭, ȯÀÚ´Â À§°¡ ³²´Â´Ù´Â ¾Èµµ°¨À» °¡Áú ¼ö ÀÖ¾ú½À´Ï´Ù. ±×·±µ¥ À§°¡ ³²´Â´Ù´Â °ÍÀÌ ²À ÁÁÀº Àϸ¸Àº ¾Æ´Õ´Ï´Ù. µÎ °¡Áö ÀÌÀ¯ÀÔ´Ï´Ù. (1) ÇùÂø°ú ¿ª·ù¼º ½Äµµ¿°, (2) ÀÜÀ§ÀÇ Á¾¾çÀÌ ±×°ÍÀÔ´Ï´Ù.

Proximal gastrectomy ÈÄ ÇùÂøÀº balloon dilatationÀ¸·Î ÇØ°áÇÒ ¼ö ÀÖ½À´Ï´Ù. ±×·±µ¥ ¿ª·ù¼º ½Äµµ¿°Àº Á¤¸» Á¶ÀýÇϱ⠾î·Æ½À´Ï´Ù. ¿Â°® ¾àÀ» ´Ù ½áµµ È£ÀüµÇÁö ¾Ê´Â °æ¿ì°¡ ÀÖÀ¸¸ç, °á±¹ total gastrectomy±îÁö ÇØ ÁÖ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù.

Proximal gastrectomy ÈÄ ÇùÂø

Proximal gastrectomy ÈÄ ÇùÂø°ú ¿ª·ù¼º ½Äµµ¿°

À§¾ÏÀº ¿ø·¡ ¿øÀ§ºÎ¿¡ ÈçÇÕ´Ï´Ù. ±ÙÀ§ºÎ À§¾Ï ȯÀÚ¿¡¼­ ¾Ï ºÎÀ§¸¸ Á¦°ÅÇÏ°í ¿øÀ§ºÎ À§Á¡¸·À» ³²°ÜµÐ´Ù´Â °ÍÀº metachronous neoplasmÀÇ À§ÇèÀÌ ÀÖ½À´Ï´Ù. ¾Æ·¡ ȯÀÚ´Â proximal gastrectomy ÈÄ ÀÜÀ§ üÇϺΠ¼Ò¸¸¿¡ 3.6cm °íµµ¼±Á¾ÀÌ ¹ß»ýÇÏ¿© ÀÇ·ÚµÈ °æ¿ìÀÔ´Ï´Ù. ESD + ablationÀ¸·Î Ä¡·áÇÏ¿´½À´Ï´Ù¸¸ Á¢±ÙÀÌ ¾î·Á¿ö »ó´çÈ÷ Èûµé¾ú½À´Ï´Ù.

ÀÜÀ§ ¼±Á¾ ¹ß°ß ´ç½Ã ¸ð½À

ESD for adenoma with HGD after proximal gastrectomy

ÃÖ±Ù¿¡´Â proximal gastrectomy with EJ stomyÀÇ ¼ú±â¿¡ ¸î °¡Áö º¯È­¸¦ Àû¿ëÇÏ¿© ´Ù½Ã ½ÃÇàµÇ´Â °æ¿ì°¡ ÀÖ½À´Ï´Ù.


2. Proximal gastrectomy with double tract recontstruction (DTR)

¼ö¼úÀå¸é YouTube

Proximal gastrectomy¿¡ ´ëÇÑ Pros and Cons Âù¹ÝÅä·ÐÀÌ ÀÖ´Ù´Â ¼Ò½ÄÀ» µè°í 2015³â 5¿ù 23ÀÏ (Åä) °­³²¼¼ºê¶õ½ºº´¿ø¿¡¼­ ¿­¸° '2015³â ´ëÇÑÁ¾¾ç¿Ü°úÇÐȸ ¿¬¼ö°­ÁÂ'¿¡ ´Ù³à¿Ô½À´Ï´Ù.

¼­¿ï´ëºÐ´çº´¿ø ¹ÚµµÁß ¼±»ý´Ô ¹ßÇ¥:

°ú°Å proximal gastrectomy with esophagogastrostomy ÈÄ reflux esophagitis, stricture¿Í °°Àº Èıâ ÇÕº´ÁõÀÌ ¸¹¾Æ¼­ ÃÖ±Ù¿¡´Â total gastrectomy°¡ ´ë¼¼ÀÔ´Ï´Ù. ¿Ü°ú ±³°ú¼­¿¡µµ proximal gastrectomy¸¦ ÃßõÇÏÁö ¾Ê°í ÀÖ½À´Ï´Ù. ÃÖ±Ù ºÐ´ç¼­¿ï´ëº´¿ø¿¡¼­´Â ±ÙÀ§ºÎ Á¶±âÀ§¾Ï¿¡ ´ëÇÏ¿© laparoscopic proximal gastrectomy (LPG) with double tract reconstruction (DTR)À» ½ÃÇàÇÏ°í ÀÖ½À´Ï´Ù.

½Äµµ¿Í À§ »çÀÌ¿¡ 10-15 cm °£°ÝÀ» À¯ÁöÇÏ¸é ¿ª·ù¼º ½Äµµ¿°Àº Å« ¹®Á¦°¡ µÇÁö ¾Ê´Â °Í °°½À´Ï´Ù. 51¿¹ÀÇ LPG with DTR Áõ·Ê¸¦ laparoscopic total gastrectomy¿Í ÈÄÇâÀûÀ¸·Î ºñ±³ÇØ º¸¾Ò´Âµ¥, reflux esophagitis°¡ °ÅÀÇ ¹ß»ýÇÏÁö ¾Ê¾Ò°í ºóÇ÷µµ Àû¾ú½À´Ï´Ù. ÇöÀç ÀüÇâÀû ¿¬±¸ÀÎ KLASS-05¿¬±¸¸¦ ÁøÇàÇÏ°í ÀÖ½À´Ï´Ù.

¾ÆÁÖ´ëÇб³ ÇãÈÆ ±³¼ö´Ô ¹ßÇ¥:

Oncologic safety°¡ Áß¿äÇÕ´Ï´Ù. Proximal gastrectomy¿¡¼­´Â 5¹ø, 6¹ø node dissection¸¦ ¸øÇϴµ¥ ÀÌ ºÎÀ§´Â EGC¿¡¼­´Â °ÅÀÇ ¹®Á¦°¡ ¾ø½À´Ï´Ù¸¸ AGC¿¡¼­ 1% Á¤µµ ¸²ÇÁÀýÀüÀÌ°¡ ÀÖ½À´Ï´Ù. ¼ö¼úÀü EGC·Î »ý°¢ÇßÀ¸³ª ¼ö¼ú ÈÄ AGC·Î ³ª¿Â ȯÀÚ°¡ °¡´ÉÇϹǷΠÁÖÀÇÇØ¾ß ÇÕ´Ï´Ù. °Ô´Ù°¡ ³²¾ÆÀÖ´Â distal stomachÀÇ ¾Ï ¹ß»ý¿¡ ´ëÇÑ °æ°è¸¦ ´ÊÃß¸é ¾È µË´Ï´Ù.

Laparoscopic proximal gastrectomy (LPG) with double tract reconstruction (DTR)¿¡ ´ëÇÑ ´Ù±â°ü ÀüÇâÀû ¿¬±¸(KLASS-05)°¡ ÁøÇàµÇ¾ú°í 2023³â ¹ßÇ¥µÇ¾ú½À´Ï´Ù (JAMA Open 2023). ÃàÇÏÇÕ´Ï´Ù. °á·Ð ºÎºÐÀ» ¿Å±é´Ï´Ù.

"This multicenter RCT showed that patients with upper-third early GC who received LPG-DTR required less vitamin B12 supplementation than those who received LTG, with no increase in complication rates and no difference in overall and disease-free survival rates. There was no difference in change in hemoglobin levels between the groups. In addition, the LPG-DTR group had better scores on physical and social functioning scales than the LTG group. These findings suggest that LPG-DTR may be as safe as LTG and a function-preserving procedure for the treatment of patients with upper-third early GC."


3. Cases

High body (cardia Á÷ÇϺÎ) ¾Ï ȯÀÚÀÔ´Ï´Ù (À§¾Ï 707). Proximal gastrectomy with double tract reconstruction ¼ö¼úÀ» ±ÇÇÏ¿´½À´Ï´Ù. °á°ú´Â Àß ³ª¿Ô½À´Ï´Ù.

(2017, 70´ë ¿©¼º)
Stomach, subtotal proximal gastrectomy: Early gastric carcinoma
1. Location : upper third, Center at body and posterior wall
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, poorly (solid) differentiated
4. Histologic type by Lauren : intestinal
5. Size : 1.3x0.7 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 1.7 cm, distal 4.2 cm
8. Lymph node metastasis : no metastasis in 29 regional lymph nodes (pN0) (0/29: "8a", 0/4; "11p", 0/4; "12a", 0/0; "4sb", 0/0; "1", 0/0; "3", 0/7; "4", 0/0; "7", 0/3; "9", 0/4; "2", 0/0; perigastric LN, 0/7)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. Associated findings : gastritis cystica profunda
13. AJCC stage by 8th edition: pT1a N0

¼ö¼ú °úÁ¤Àº ¾Æ·¡¿Í °°¾Ò½À´Ï´Ù.

Laparoscopic subtotal gastrectomy proximal gastrectomy with double tract reconstruction
. Intracorporeal anastomosis
. Energy device : Harmonic scalpel
. Supine position
. Subumbilical incision 12mm
. Midaxillary lineÀÇ Rt upper (5)mm Lt upper (5)mm
. Midclavicular lineÀÇ Rt lower (12)mm Lt lower (12)mm
→ Omentectomy was performed (Partial)
→ Distal resection EndoGIA60
→ LN dissection (Yes), D1+¥â LN dissection with vagotomy
→ Transverse 4cm incision for specimen retrieval
→ Esophageal preparation with reusable
→ Roux-en-Y-esophagojejunostomy with EEA 25 £«EndoGIA60
→ Jejunojejunostomy with EndoGIA60
→ Frozen section of distal margin (Yes) : (£­) with 5cm
→ Frozen section of proximal margin (Yes) : (£­) with 3cm
→ Bleeding control and JP catheter insertion 1 at Lt subphrenic
→ Layer by layer closure
→ GJ was done with EndoGIA 60mm x2


4. Proximal gastrectomy with DTR ÈÄ remnant distal stomachÀÇ °üÂû

À§¸¦ ÀϺΠ³²±â±â À§Çؼ­´Â proximal gastrectomy ÈÄ jejunal interpositionÀ̳ª double tract reconstructionÀ» Çؼ­ ½Äµµ¿Í À§°¡ ¹Ù·Î ¸¸³ªÁö ¾Ê°Ô Çϸé ÁÁ½À´Ï´Ù. ÀúÈñ ±â°ü¿¡¼­´Â double tract reconstruction (DTR)À» ¼±È£ÇÏ°í Àִµ¥¿ä... ¹®Á¦´Â total gastectomy ÈÄ E-J stomy¿Í double tract reconstruction ÈÄ E-J stomy°¡ °ÅÀÇ ºñ½ÁÇØ º¸À̹ǷΠ³»½Ã°æÀǻ簡 remnant distal stomachÀ» °üÂûÇÏÁö ¾Ê´Â °æ¿ì°¡ ÀÖ´Ù´Â °ÍÀÔ´Ï´Ù. DTR ¼ö¼úÀÎ °ÍÀ» ¾Ë°í remnant distal stomachÀ» °üÂûÇÏ·Á°í Çصµ Á¢±ÙÀÌ ¾î·Æ°Å³ª anatomy°¡ Çò°¥¸®´Â °æ¿ìµµ ¸¹½À´Ï´Ù.

DTR ¼ö¼ú ȯÀÚÀÇ ³»½Ã°æ °Ë»ç¸¦ Áõ·Ê·Î ¼Ò°³ÇÏ°Ú½À´Ï´Ù.


Stomach, proximal gastrectomy:
. Early gastric carcinoma
1. Location : upper third, Center at cardia (Siewert II) and lesser curvature
2. Gross type : EGC type IIc+IIa
3. Histologic type : tubular adenocarcinoma, poorly differentiated
4. Histologic type by Lauren : intestinal
5. Size : 1.9x1.2 cm
6. Depth of invasion : invades mucosa (muscularis mucosae) (pT1a)
7. Resection margin: free from carcinoma, safety margin: proximal 0.3 cm, distal 12.3 cm
8. Lymph node metastasis : no metastasis in 47 regional lymph nodes (pN0) (0/47: "1", 0/0; "2", 0/5; "3", 3/21; "4", 0/3; "8a", 0/4; "7", 0/4; "9", 0/2; "11p", 0/3; "12a", 0/5)
9. Lymphatic invasion : not identified
10. Venous invasion : not identified
11. Perineural invasion : not identified
12. AJCC stage by 7th edition: pT1a N0


[FAQs]

[2015-5-25. ¾Öµ¶ÀÚ Áú¹®]

Proximal gastrectomyÀÇ »õ·Î¿î ¼ö¼ú¹ý¿¡ ´ëÇÑ ¸ð½Äµµ´Â ¸¹Àº µµ¿òÀÌ µÇ¾ú½À´Ï´Ù.

ÇÑ°¡Áö °ÆÁ¤½º·¯¿î Á¡Àº proximal gastrectomy with EJ ÈÄ screeningÀº ¾î¶»°Ô µÉÁö ±Ã±ÝÇÕ´Ï´Ù. ¾ÈÂÊÀ¸·Î µé¾î°¡¼­ °üÂûÇϱⰡ ¾î·ÆÁö´Â ¾ÊÀ»Áö...

[2015-5-27. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. ÀÏ°ß total gastrectomy ÈÄ À§¸¦ °üÂûÇÏ´Â °Í°ú ºñ½ÁÇÒ °Í °°´Ù´Â »ý°¢ÀÌ µì´Ï´Ù. ±×·¯³ª »ó¼¼ÇÑ °ÍÀº ¾Ë ¼ö ¾ø¾î¼­ ºÐ´ç ¼­¿ï´ëº´¿ø ¹ÚµµÁß ¼±»ý´Ô²² ¹®ÀÇÇÏ¿© ¾Æ·¡¿Í °°Àº ´äº¯À» ¹Þ¾Ò½À´Ï´Ù.

ÀÌÁØÇà ±³¼ö´Ô. À§³»½Ã°æ ÇÏ´Â µ¥´Â Ưº°È÷ ¹®Á¦°¡ ¾ø½À´Ï´Ù. ´Ù¸¸ ¹Ýµå½Ã ÀÜÀ§¸¦ ºÁ´Þ¶ó°í °Ë»ç¿À´õ ºñ°í¶õ¿¡ Ç¥±âÇÏ°í ÀÖ½À´Ï´Ù. ¸¸ÀÏ ÀÌ·¯ÇÑ ÄÚ¸àÆ®°¡ ¾øÀ¸¸é ¼ÒÈ­±â³»°ú¿¡¼­ À§ÀüÀýÁ¦ ÇÑ ÁÙ ¾Ë°í ÀÜÀ§¸¦ ¾Èº¼ ¼ö Àֱ⠶§¹®ÀÔ´Ï´Ù. °¨»çÇÕ´Ï´Ù.

¿Ü°ú-³»°ú »çÀÌ ¼ÒÅ븸 Àß µÇ¸é ¹®Á¦°¡ ¾ø´Ù´Â ¸»¾¸ °°½À´Ï´Ù. ¿Ü°ú ȯÀÚ°¡ Á¤È®È÷ ¾î¶² ¼ö¼úÀ» ¹Þ¾Ò´ÂÁö Àß ¾Ë°í ¼ö¼úÇÏ´Â °ÍÀº ³»½Ã°æ ÀÇ»çÀÇ ±âº»À̶ó°í »ý°¢ÇÕ´Ï´Ù. Ç×»ó ½¬¿î ÀÏÀº ¾Æ´Ï°ÚÁö¸¸...

[2016-10-25. °í½Å´ë Á¤°æ¿ø ±³¼ö´Ô ÆíÁö]

¾È³çÇϼ¼¿ä, ÀÌÁØÇà ±³¼ö´Ô !

¿À·£¸¸¿¡ proximal gastrectomy¿¡ °ü·ÃµÈ ³»¿ëÀÌ ¿Í¼­, ÀÌÀü¿¡ Ȥ½Ã³ª µµ¿òÀÌ µÇ¾úÀ¸¸é ÇÏ°í ÀúÀåÇصξú´ø »çÁøÀ» º¸³»µå¸³´Ï´Ù.

ÀÌ È¯ÀÚÀÇ °æ¿ì 2³â Á¤µµ´Â comment¿¡ ÀÜÀ§³ª proximal gastrectomy¿¡ ´ëÇÑ ¾ð±ÞÀÌ ¾ø¾î¼­ ÀÌÀü °Ë»ç¿¡¼­´Â total gastrectomyó·³ ³»½Ã°æ »çÁøÀÌ ÂïÇô ÀÖ¾ú´Âµ¥, ±× ÀÌÈÄ¿¡ comment¿¡ proximal gastrectomy ¾ð±ÞÀÌ ÀÖ¾î ±³¼ö´ÔÀÇ ¸ÞÀÏÀÌ »ý°¢³ª Á¶½É½º·´°Ô ÁøÀÔÇؼ­ µé¾î°¡ º¸¾Ò°í, ´ç½Ã¿¡ ½Å±âÇØÇß´ø ÄÉÀ̽ºÀÔ´Ï´Ù.

Á¦°¡ óÀ½ º» proximal gastrectomy with DTR ³»½Ã°æ »çÁøÀ̱⿡ ÀúÀåÀ» Çسõ¾Ò´Ù°¡ ÀØ°í ÀÖ¾ú´Âµ¥ À̹ø¿¡ °£´ÜÇÏ°Ô »çÁø Á¤¸®¸¦ Çغ¸¾Ò½À´Ï´Ù.

ÀÌ È¯ÀÚÀÇ °æ¿ì ÀÜÀ§°¡ Á» ÀÛÀº ÆíÀÌ°í, bile reflux·Î ÀÎÇÑ change°¡ Á» ½ÉÇÑ ÆíÀÌÁö¸¸, ±×·¡µµ Ȥ½Ã³ª ±Û·Î¸¸ º¸´Ù°¡ ÀÌ·± ÄÉÀ̽º¸¦ Á÷Á¢ ³»½Ã°æÀûÀ¸·Î º¸¸é, ¿©·¯ µ¶ÀÚµéÀÌ È¤½Ã³ª µµ¿òÀÌ µÉ µí ÇÏ¿© º¸³»µå¸³´Ï´Ù.

Á¤°æ¿ø ¿Ã¸².

[2016-10-26. ÀÌÁØÇà ´äº¯]

ÁÁÀº »çÁø °¨»çÇÕ´Ï´Ù.

±×·¸½À´Ï´Ù. ÁÁÀº ³»½Ã°æ °Ë»ç¸¦ À§Çؼ­´Â ÁÁÀº Á¤º¸°¡ ÇÊ¿äÇÕ´Ï´Ù. ³»½Ã°æÀ» ÀÇ·ÚÇÏ´Â ºÐÀº ÃæºÐÇÑ Á¤º¸¸¦ ÁÖ¼Å¾ß ÇÕ´Ï´Ù. ³»½Ã°æ ½Ã¼úÀڴ ȯÀÚÀÇ ÀÓ»ó Á¤º¸¸¦ Àß È®ÀÎÇÑ ÈÄ ½ÃÀÛÇØ¾ß ÇÕ´Ï´Ù. ¼­·Î ³ë·ÂÇսôÙ.

[2020-12-5] ´ëÇÑ»óºÎÀ§Àå°üÇ︮ÄÚ¹ÚÅÍÇÐȸ ½ÉÆ÷Áö¾ö. ÀÌÇõÁØ ±³¼ö´Ô °­ÀÇ ¸¶Áö¸· ½½¶óÀ̵å

Function preserving surgery in gastric cancer
1. Á¾·ù: À¯¹®º¸Á¸À§ÀýÁ¦¼ú PPG, ±ÙÀ§ºÎÀ§ÀýÁ¦¼ú PG, °¨½Ã¸²ÇÁÀý¼ö¼ú SNNS
2. ÇöȲ: ÀϺΠ±â°üÀº È°¹ßÈ÷ ½ÃÇàÇϳª ÀüüÀûÀ¸·Î´Â µå¹°°Ô ½ÃÇàµÊ
- PPG, PG: Ç¥ÁØ ¼ö¼ú·Î¼­ ½ÃÇàµÊ
- SNNS: ¿¬±¸¸ñÀû ¼ö¼ú
3. Àå´ÜÁ¡
- PPG: ¿µ¾çÇÐÀû ÀÌÁ¡, ´ýÇËÁõÈıº/´ã¼®¹ß»ýÀÌ ÀûÀ½ vs À§¹èÃâÁö¿¬, ÀåÁ¡ÀÌ ¶Ñ·ÇÇÏÁö ¾ÊÀ½
- PG: ¿µ¾çÇÐÀû ÀÌÁ¡, vit B12°áÇÌ/ö°áÇ̼ººóÇ÷ÀÌ ÀûÀ½ vs ¿ª·ù¼º½Äµµ¿°, ÀåÁ¡ÀÌ ¶Ñ·ÇÇÏÁö ¾ÊÀ½
- SNNS: ¿µ¾çÇÐÀû ÀÌÁ¡, »îÀÇ Áú Çâ»ó ±â´ë vs À§À½¼ºÀÇ À§Ç輺, µ¥ÀÌÅÍ°¡ ºÎÁ·ÇÔ
4. ÇâÈÄ Àü¸Á
- Àӻ󿬱¸¸¦ ÅëÇÑ ±Ù°Å âÃâ (KLASS-04, KLASS-05, SENORITA...)
- ¼ö¼ú ÈÄ »îÀÇ Áú¿¡ ´ëÇÑ Á߿伺 °­Á¶, ¼ö¼ú ±â±¸ÀÇ ¹ßÀüÀ¸·Î ½ÃÇà ºóµµ´Â ´Ã °ÍÀ¸·Î ¿¹»ó

[2024-10-3] ÀϺ» ¿¬±¸ÀÚµéÀÌ proximal gastrectomy ÈÄ ³»½Ã°æ °üÂûÀ» À§ÇÏ¿© À§¸¦ »õ·Ó°Ô ±¸È¹ÇÏ¿´½À´Ï´Ù. (J Gastric Cancer 2024)


[References]

1) Proximal gastrectomy for gastric cancer (2015) - ¹ÚµµÁß ¼±»ý´ÔÀÇ Á¾¼³

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.