A 3-Arm case-matched analysis of anti-reflux reconstruction methods after laparoscopic proximal gastrectomy - Single tract jejunal interposition vs double tract reconstruction vs tube-like stomach reconstruction

Zhen Tian; Yifan Cheng; Yong Wang; Jun Ren; Sen Wang; Daorong Wang

doi:10.1016/j.ejso.2024.109482

A 3-Arm case-matched analysis of anti-reflux reconstruction methods after laparoscopic proximal gastrectomy - Single tract jejunal interposition vs double tract reconstruction vs tube-like stomach reconstruction

Eur J Surg Oncol. 2024 Nov 19;51(2):109482. doi: 10.1016/j.ejso.2024.109482. Online ahead of print.

Authors

Zhen Tian¹, Yifan Cheng¹, Yong Wang², Jun Ren³, Sen Wang⁴, Daorong Wang⁵

Affiliations

¹ Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China.
² Scientific Research Department, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China.
³ Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China.
⁴ Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China. Electronic address: wangsen1992@hotmail.com.
⁵ Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Yangzhou, China; Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou, China; General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, China. Electronic address: wdaorong666@sina.com.

PMID: 39580964
DOI: 10.1016/j.ejso.2024.109482

Abstract

Background: Owing to reportedly superior prognosis, proximal gastrectomy (PG) is expected to be an alternative to total gastrectomy for upper gastric cancer. However, limited data are available regarding the optimal anti-reflux reconstruction method after PG. This study aimed to evaluate the effect of laparoscopic PG with single-tract jejunal interposition (LPG-STJI), double-tract reconstruction (LPG-DTR), and tube-like stomach reconstruction (LPG-TLR) on surgical outcomes in patients with upper-third gastric cancer.

Methods: Using propensity score-matching (PSM) to adjust for baseline characteristics, a well-balanced cohort was established by matching each patient who underwent LPG-STJI as the study group with one who underwent LPG-DTR or LPG-TLR as the control group at a 1:1 ratio. This study was registered at ClinicalTrials.gov (No. NCT06347757).

Results: PSM yielded 62 matched pairs, with comparable demographic and tumor characteristics. The incidence of reflux esophagitis at one year postoperatively was significantly lower in the LPG-STJI and LPG-DTR groups than in the LPG-TLR group (11.3 % vs 9.7 % vs 24.2 %, P = 0.046), and fewer patients required proton-pump inhibitor administration (62.9 % vs 56.5 % vs 79.0 %, P = 0.024). In terms of nutritional status, the LPG-STJI group showed minimal changes in postoperative body weight and nutrition-related biochemical indices, approaching preoperative levels by the 12-month mark. In addition, the LPG-STJI group demonstrated a more favorable quality of life than the LPG-DTR and LPG-TLR groups, as assessed using the EORTC QLQ-C30 and QLQ-STO22 questionnaires.

Conclusion: LPG-STJI may be the preferred option for anti-reflux reconstruction, since it appears to reduce the occurrence of endoscopic reflux esophagitis and improve quality of life without raising surgical complications or compromising nutritional status. Further well-designed prospective studies are warranted to re-evaluate these findings.

Keywords: Double-tract reconstruction; Proximal gastrectomy; Single tract jejunal interposition; Tube-like stomach reconstruction.

Associated data

ClinicalTrials.gov/NCT06347757