Purpose: Treatment strategy for esophagogastric junction (EGJ) carcinoma has been controversial for a long time. Standard operation， especially standard reconstruction method has not been established yet. We developed a new reconstruction method in laparoscopic proximal gastrectomy for EGJ carcinoma， which is a simple and safe procedure. In this paper， I explain our strategy and the technique of reconstruction for EGJ carcinoma.

 

Methods: Laparoscopic proximal gastrectomy with transhiatal lower esophagectomy is performed. In regards to the reconstruction， we have adopted two methods. One is our original esophagogastric tube (EGT) reconstruction with pseudo-fornix created by a no-knife linear stapler.  It’s a simple and tension free procedure with only one anastomosis.  However， its long-term outcome about reflux esophagitis is still unknown.  Then， mainly for the patients who cannot take PPI lifelong， double-tract (DT) reconstruction is selected.

 

Results: From April 2011， we performed laparoscopic proximal gastrectomy with transhiatal or transthoracic/thoracoscopic esophagectomy in 33 patients with EGJ carcinoma. EGT reconstruction was done in 27 patients and DT was done in 6 patients. Median operation time was 306 min. in EGT and 377 in DT. Surgical complications included 1 anastomotic leakage and 3 anastomotic stenoses in EGT， and 1 anastomotic leakage in DT. Postoperative reflux symptoms are well controlled in all patients.

 

Conclusion: Laparoscopic esophagogastric tube reconstruction is a tension free and simple procedure with only one anastomosis. Although long-term follow-up and a larger number of patients are required， our procedures would be the treatment of choice for EGJ carcinoma.