Purpose Proximal gastrectomy (PG) is a function-preserving surgery in cases of proximally located early-stage gastric cancer. Because gastroesophageal reflux is a major pitfall of this operation, we devised a modified esophagogastrostomy (EG) anastomosis to fix the distal part of the posterior esophageal wall to the proximal part of the anterior stomach wall to produce an anti-reflux mechanism; we named this the SPADE operation. This study aimed to show demonstrate the clinical outcomes of the SPADE operation and compare them to those of previous PG cases. Materials and Methods Case details of 56 patients who underwent PG between January 2012 and March 2018 were retrospectively reviewed: 30 underwent conventional esophagogastrostomy (CEG) anastomosis using a circular stapler, while 26 underwent the SPADE operation. Early postoperative clinical outcome-related reflux symptoms, endoscopic findings, and postoperative complications were compared in this case–control study. Results Follow-up endoscopy showed more frequent reflux esophagitis cases in the CEG group than in the SPADE group (30% vs. 15.3%, P=0.19). Similarly, bile reflux (26.7% vs. 7.7%, P=0.08) and residual food (P=0.01) cases occurred more frequently in the CEG group than in the SPADE group. In the CEG group, 13 patients (43.3%) had mild reflux symptoms, while 3 patients (10%) had severe reflux symptoms. In the SPADE group, 3 patients (11.5%) had mild reflux symptoms, while 1 had severe reflux symptoms (absolute difference, 31.8%; 95% confidence interval, 1.11–29.64; P=0.01). Conclusions A novel modified EG, the SPADE operation, has the potential to decrease gastroesophageal reflux following a PG.

中文翻译：

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近端胃切除术后使用双缝线将食管后壁固定到胃前壁的铲形吻合（SPADE 手术）：早期结果的病例对照研究

目的 近端胃切除术 (PG) 是一种在近端早期胃癌病例中保留功能的手术。由于胃食管反流是该手术的主要缺陷，我们设计了一种改良的食管胃造口术（EG）吻合术，将食管后壁的远端固定到胃前壁的近端，以产生抗反流机制；我们将其命名为 SPADE 操作。本研究旨在展示 SPADE 手术的临床结果，并将其与之前的 PG 病例进行比较。材料与方法 回顾性分析了 2012 年 1 月至 2018 年 3 月期间接受 PG 的 56 例患者的病例细节：30 例接受了使用圆形吻合器的常规食管胃造口术（CEG）吻合术，而 26 例接受了 SPADE 手术。本病例对照研究比较了术后早期临床结果相关的反流症状、内镜检查结果和术后并发症。结果 内镜随访显示，CEG 组反流性食管炎的发生率高于 SPADE 组（30% vs. 15.3%，P=0.19）。同样，与 SPADE 组相比，CEG 组的胆汁反流（26.7% 对 7.7%，P=0.08）和食物残渣（P=0.01）的发生率更高。CEG组13例（43.3%）有轻度反流症状，3例（10%）有重度反流症状。在 SPADE 组中，3 名患者（11.5%）有轻度反流症状，而 1 名有严重反流症状（绝对差异，31.8%；95% 置信区间，1.11-29.64；P=0.01）。结论 一种新的改良 EG，即 SPADE 手术，有可能减少 PG 后的胃食管反流。