Purpose To evaluate the feasibility and safety of intracorporeal overlapping gastrogastrostomy between the proximal anterior wall and antrum posterior wall (PAAP; PAAP anastomosis) of the stomach in minimally invasive pylorus-preserving gastrectomy (PPG) for early gastric cancer (EGC). Materials and Methods From December 2016 to December 2019, 17 patients underwent minimally invasive PPG with PAAP anastomosis for EGC in the high body and posterior wall of the stomach. Intraoperative gastroscopy was performed with the rotation maneuver during proximal transection. A longer antral cuff (>4–5 cm) was created for PAAP than for conventional PPG (≤3 cm) at the point where a safe distal margin and good vascular perfusion were secured. Because the posterior wall of the proximal remnant stomach was insufficient for intracorporeal anastomosis, the anterior wall was used to create an overlapping anastomosis with the posterior wall of the remnant antrum. The surgical and oncological outcomes were analyzed, and the stomach volume was measured in patients who completed the 6-month follow-up. The results were compared to those after conventional PPG (n=11 each). Results PAAP anastomosis was successfully performed in 17 patients. The proximal and distal resection margins were 2.4±1.9 cm and 4.0±2.6 cm, respectively. No postoperative complications were observed during the 1-year follow-up esophagogastroduodenoscopy (n=10). The postoperative remnant stomach (n=11) was significantly larger with PAAP than with conventional PPG (225.6±118.3 vs. 99.1±63.2 mL; P=0.001). The stomach length from the anastomosis to the pylorus was 4.9±2.4 cm after PAAP. Conclusions PAAP anastomosis is a feasible alternative for intracorporeal anastomosis in minimally invasive PPG for highly posteriorly located EGC.

中文翻译：

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位于胃高体和后壁的早期胃癌微创保留幽门胃切除术中的近端前-胃后部（PAAP）重叠吻合

目的评价早期胃癌（EGC）微创保留幽门胃切除术（PPG）中胃近端前壁与胃窦后壁（PAAP；PAAP吻合）体外重叠胃吻合术的可行性和安全性。材料与方法 2016年12月至2019年12月，17例患者行胃高体及后壁EGC微创PPG-PAAP吻合术。术中胃镜检查在近端横断过程中采用旋转手法进行。在确保安全的远端边缘和良好的血管灌注的点上，为 PAAP 创建了比传统 PPG (≤3 cm) 更长的胃窦袖带 (>4–5 cm)。由于近端残胃后壁不足以进行体内吻合，前壁用于与残余胃窦后壁形成重叠吻合。分析了手术和肿瘤学结果，并测量了完成 6 个月随访的患者的胃体积。将结果与常规 PPG 后的结果（每个 n = 11）进行比较。结果 17例患者成功完成PAAP吻合。近端和远端切除边缘分别为 2.4±1.9 cm 和 4.0±2.6 cm。在随访 1 年的食管胃十二指肠镜检查中未观察到术后并发症（n=10）。PAAP 组术后残胃 (n=11) 明显大于传统 PPG 组 (225.6±118.3 vs. 99.1±63.2 mL；P=0.001)。PAAP后吻合口至幽门的胃长为4.9±2.4 cm。