Tegafur/Uracil

Preventing gastroesophageal reflux after proximal gastrectomy for proximal gastric and esophagogastric junction cancer remains challenging due to the lack of standardized reconstructive techniques. The double flap technique (DFT) in valvuloplastic esophagogastrostomy prevents reflux esophagitis but is less effective in esophagogastric junction cancer because of negative pressure on the inferior mediastinum. We developed the U‐shaped flap technique (UFT) to enhance the anti‐reflux efficacy.

This study analyzed data from patients who underwent minimally invasive proximal gastrectomy for proximal gastric and esophagogastric junction cancer between August 2014 and May 2022, using a prospectively maintained database. We compared DFT and UFT for short‐ and long‐term outcomes, focusing on gastroesophageal reflux, using one‐to‐one propensity score matching to control for patient‐related variables.

Among 217 eligible patients, 205 (100 in DFT, 105 in UFT) completed a 1‐year follow‐up. After propensity score matching, we selected 42 pairs of patients who underwent DFT and UFT. UFT had significantly shorter operative time (p = 0.044), similar blood loss, and similar morbidity. The UFT group had significantly fewer reflux symptoms (0% vs. 14.3%, p = 0.0011) and endoscopic Los Angeles grade B or higher reflux esophagitis (0% vs. 14.3%, p = 0.0011) than the DFT group. In lower mediastinal reconstructions for esophagogastric junction cancer, UFT showed a reduced incidence of reflux esophagitis.

Our study indicates that the U‐shaped flap technique (UFT) offered significant advantages in reducing postoperative reflux symptoms and endoscopic esophagitis, in a cohort of patients with proximal gastric and esophagogastric junction cancer.

An 86-year-old man underwent laparoscopic ileocecal resection with lymph node dissection(pT3N0M0, Stage Ⅱa, Ly1a, V1a). The patient did not receive any adjuvant chemotherapy. Two years later, the patient was diagnosed with a recurrence at the anastomotic site(RAS mutant, HER2 negative, MSI-low). After 4 courses of FOLFOX plus bevacizumab, the patient was admitted for ileus. Preoperative echocardiography revealed an ejection fraction(EF)of 35% and BNP level of 562.2 pg/ mL. Therefore, asymptomatic cardiomyopathy was suspected because of bevacizumab administration. Although the last bevacizumab dose was administered within 2 weeks, we performed a laparoscopic tumor resection with lymph node dissection. Histological examination revealed colon cancer recurrence without lymph node metastasis. The patient was discharged on 19 POD without heart failure and had no recurrence of UFT/UZEL for 11 months. Three months after surgery, EF increased to 61% and BNP level was 14 pg/mL. VEGF inhibitors are associated with a very high risk of cardiomyopathy according to the ESC guidelines(2022). These side effects in conversion therapy for cancer should be carefully considered, even though they are rare.