ロボット支援下噴門側胃切除術における観音開き再建法の導入—手術手技と術後短期成績の比較検討

Introduction of the valvuloplastic esophagogastrostomy by double flap technique in robot-assisted proximal gastrectomy : Surgical procedures and comparative short-term outcomes

◆要旨：当教室では，噴門側胃切除術後の胃酸逆流予防策として，食道残胃吻合の再建法として従来採用していたside-overlap法（SO）に代わり観音開き法（double-flap technique：DFT）を導入した．2020年から2024年に当教室でロボット支援下噴門側胃切除術を施行した早期胃癌20例を対象とし，SO群14例，DFT群6例を後方視的に解析することで，DFT導入後の短期成績を比較検討した．DFT群では術後逆流性食道炎の発症が有意に少なく，吻合部狭窄や縫合不全などの合併症も認めなかった．手術時間，出血量，在院日数に有意差はなく，DFTは安全に導入可能で，逆流防止に有用な再建法と考えられた．

　Proximal gastrectomy（PG） is a function-preserving surgery indicated for early-stage upper gastric cancer. However, the risk of postoperative reflux esophagitis remains a major concern, and reconstruction techniques play a key role in preventing this complication. At our institution, we introduced the valvuloplastic esophagogastrostomy by double flap technique（VEG-DFT） as an alternative to the previously used side-overlap（SO） method to enhance anti-reflux outcomes after PG. This study aimed to compare the short-term surgical outcomes between the two reconstruction methods. We retrospectively analyzed 20 patients with early-stage gastric cancer（cT1bN0M0, Stage I） who underwent robotic VEG-DFT between January 2020 and February 2024. Of these, 14 patients received SO reconstruction（SO group），and 6 underwent DFT reconstruction（DFT group）． The indication for PG was a tumor confined to the upper third of the stomach with no evidence of lymph node metastasis on preoperative or intraoperative assessment. The incidence of postoperative reflux esophagitis was significantly lower in the DFT group（p＝0.011）．No anastomotic complications such as stricture or leakage were observed in either group. There were no significant differences in operative time, blood loss, or length of hospital stay between the two groups. In the DFT group, all patients were able to discontinue proton pump inhibitor therapy after surgery. In conclusion, robotic VEG-DFT was safely introduced and resulted in favorable short-term outcomes, particularly in reducing postoperative reflux. DFT may represent a promising anti-reflux reconstruction method for patients undergoing PG.