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. 2023 Jan 12:9:1052643.
doi: 10.3389/fsurg.2022.1052643. eCollection 2022.

Clinical outcomes of proximal gastrectomy with gastric tubular reconstruction and total gastrectomy for proximal gastric cancer: A matched cohort study

Jingxiao Fu  1 , Yi Li  1 , Xuechao Liu  1 , Xuelong Jiao  1 , Yuhao Wang  1 , Hongyu Qu  1 , Zhaojian Niu  1
Affiliations

Clinical outcomes of proximal gastrectomy with gastric tubular reconstruction and total gastrectomy for proximal gastric cancer: A matched cohort study

Jingxiao Fu et al. Front Surg. .

Abstract

Background: Proximal gastrectomy with gastric tubular reconstruction is a surgical procedure that can preserve function in patients with proximal gastric cancer. However, whether gastric tubular reconstruction with proximal gastrectomy has certain advantage in some aspects over total gastrectomy is controversial. To evaluate the benefit of gastric tubular reconstruction after proximal gastrectomy, we compared gastric tubular reconstruction with total gastrectomy for proximal gastric cancer.

Method: A total of 351 patients were enrolled. Concurrent total gastrectomy patients matched with the Proximal gastrectomy group in age, sex, body mass index, clinical stage, and ASA score were selected by propensity score matching. Preoperative basic information, perioperative indicators, histopathological features, postoperative complications and nutritional status, reflux were compared between the two groups.

Results: There was no significant difference in the incidence of reflux between two groups (14.8% and 6.5% respectively, P = 0.085). There were significant differences between the two groups in bowel function recovery (2.29 ± 1.16 vs. 3.01 ± 1.22; P = 0.039) and start of soft diet (4.06 ± 1.81 vs. 4.76 ± 1.69; P = 0.047). There were no significant differences between the two groups in nutritional status one year after surgery. However, the decrease in serum hemoglobin in the TG group at 3 and 6 months after surgery was significantly higher than that in the PG group (P = 0.032 and 0.046, respectively). One month after surgery, %BW loss in TG group was significantly lower than that in the PG group (P = 0.024).

Conclusion: The Proximal gastrectomy group has better clinical outcome and gastric tubular reconstruction is simple, similar complications and reflux rates, gastric tubular reconstruction may be more suitable for proximal gastric cancer.

Keywords: gastric tubular reconstruction; hemoglobin; nutritional status; proximal gastrectomy; reflux esophagitis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Surgical procedure. (A) Trocar sites. (B) After the esophagus was transected, the upper part of the stomach was excised along a dashed line to create a gastric tube. Its width is about 4 cm. (C) The anterior wall of the gastric tube and the posterior wall of the esophagus were anastomosed with linear stapler. (D) After anastomosis was performed, the entry hole was closed with barbed suture. The gastric tube was anchored with the right and left crus of the diaphragm by one stitch each to prevent hiatus hernia. The length of the whole gastric tube on the greater curvature side is about 20 cm.
Figure 2
Figure 2
Schema of reconstruction after (A) proximal gastrectomy with tube gastric and (B) total gastrectomy with roux-en-Y esophagojejunostomy reconstruction.
Figure 3
Figure 3
Flow chart of patient selection and propensity score matching. The 54 patients who underwent proximal gastrectomy (PG) were matched to 108 patients who underwent total gastrectomy (TG) in terms of age, sex, body mass index, clinical stage, and American Society of Anesthesiologists (ASA) score.
Figure 4
Figure 4
Postoperative changes of prognostic nutritional index (PNI) (A), hemoglobin (B), pre-albumin (C), albumin (D), %BW loss (E) and %PMI loss (F) in the proximal gastrectomy (PG) group and total gastrectomy (TG) group. All postoperative data are represented as values (mean ± standard error) relative to preoperative.
See this image and copyright information in PMC

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