Preliminary Efficacy Analysis of Cheng's Giraffe Reconstruction After Proximal Gastrectomy
Preliminary Efficacy Analysis of Cheng's Giraffe Reconstruction After Proximal Gastrectomy
In the past years, the adenocarcinoma of the esophagogastric junction (AEG) has been
 increasing obviously in China. It may be caused by the reason of increased body weight,
 alcohol consumption, gastroesophageal reflux disease and premalignant. In western countries,
 the 5-year rate of advanced AEG was less than 30%, it was the same in China. There was
 significant difference in epidemiology, pathogenic mechanism, biological characteristics and
 prognosis between AEG and antrum tumors, so AEG was regarded as a kind of independent
 disease. Up till now, the scope of lymph node dissected, the selection of operation approach,
 the resection range and the digestive tract reconstruction for the treatment of AEG were in
 dispute, especially in the reconstruction of digestive tract after operation. The purpose of
 this study is to investigate the efficacy and safety of the proximal gastrectomy combined
 with Giraffe anastomosis for early adenocarcinoma of esophagogastric junction.
In the past years, the adenocarcinoma of the esophagogastric junction (AEG) has been
 increasing obviously in China. It may be caused by the reason of increased body weight,
 alcohol consumption, gastroesophageal reflux disease and premalignant. In western countries,
 the 5-year rate of advanced AEG was less than 30%, it was the same in China. There was
 significant difference in epidemiology, pathogenic mechanism, biological characteristics and
 prognosis between AEG and antrum tumors, so AEG was regarded as a kind of independent
 disease. Up till now, the scope of lymph node dissected, the selection of operation approach,
 the resection range and the digestive tract reconstruction for the treatment of AEG were in
 dispute, especially in the reconstruction of digestive tract after operation.

 The digestive tract reconstruction methods for AEG II were determined by the surgical
 approach. The controversy exists regarding whether reconstruction method with low esophageal
 reflux should be used to treat AEG patients. The gastric tube reconstruction, the
 antrum-preserving double-tract reconstruction and the Roux-en-Y reconstruction were the
 common methods. Some studies showed that the 24-h pH profile in the patients with gastric
 tube reconstruction was similar to the healthy person, but it may be related to the
 increasing incidence of gastroesophageal reflux disease in the healthy person and the
 anti-reflux medication used in the patients. Although the antrum-preserving double-tract
 reconstruction have a good function of anti-reflux, the complicated operation and too many
 anastomotic stomas increased the rate of postoperative happened. The common physiological
 mechanism of anti-reflux was caused by the lower esophageal sphincter, esophagogastric
 junction, His angle and so on. Therefore, in our center, we use a new reconstruction which
 combine the advantages of gastric tube reconstruction with rebuilding the His angle and
 fundus of gastric. We call it Gastric tube interposition esophagogastrostomy with
 reconstruction of His angle and fundus (Giraffe anastomosis).
Inclusion Criteria:

 1. Preoperative endoscopy and biopsy confirmed adenocarcinoma of esophagogastric
 junction, and predictively feasible of transabdominal proximal gastrectomy.

 2. Early gastric cancer, of preoperative staging AJCC 8th Edition cT1N0M0 and not
 suitable for endoscopic resection;

 3. Completion of abdominal CT scan and ultrasound endoscopy

 4. Age：18 to 70 years ;

 5. Karnofsky score ≥ 70

 6. With good compliance and informed consent required.

 Exclusion Criteria:

 1. Pregnancy, breast-feeding women.

 2. The existence of the peripheral nervous system disorders or significant neurological
 disorders and a history of central nervous system disorders.

 3. Severity mental diseases;

 4. Patients with other severe complications cannot tolerate surgery: such as severe heart
 and lung diseases, heart function below clinical stage 2, uncontrollable hypertension,
 pulmonary infection, moderate to severe COPD, chronic bronchitis, severe diabetes and
 / or renal insufficiency, severe hepatitis and / or function below the rank of CHILD B
 grade, and severe malnutrition, etc.

 5. With other malignancies which were not cured.

 6. Patients have already joined other clinical trials

 7. After signature the Clinical trial agreement, patients and their agent will quit the
 trial.