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.
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