Can Proximal Gastrectomy with Double-Tract Reconstruction Replace Total Gastrectomy? A Propensity Score Matching...

Area of Science:

• Surgical Oncology
• Gastroenterology
• Clinical Outcomes Research

Background:

• Upper early gastric cancer (EGC) presents unique surgical challenges.
• Comparing surgical techniques like proximal gastrectomy with double-tract reconstruction (PG-DTR) and total gastrectomy with Roux-en-Y (TG) is crucial for optimizing patient care.

Purpose of the Study:

• To compare the clinical outcomes of PG-DTR versus TG with Roux-en-Y reconstruction in patients with upper EGC.
• To evaluate complications, reflux morbidity, recurrence, and survival rates between the two surgical methods.

Main Methods:

• Retrospective cohort study including 104 patients (52 PG-DTR, 52 matched TG) with upper EGC (2008-2016).
• Propensity score matching was used to ensure comparability between groups based on age, sex, BMI, clinical stage, and ASA score.
• Outcomes assessed included clinicopathological characteristics, postoperative complications (early, late, severe), reflux symptoms, recurrence, and mortality.

Main Results:

• PG-DTR group had smaller tumors, resection margins, and fewer retrieved lymph nodes.
• Shorter times to diet initiation and hospital stay were observed in the PG-DTR group.
• No significant differences in early, late, or severe postoperative complication rates were found. One-year reflux morbidity and endoscopic esophagitis rates were similar.
• Five-year overall survival rates were significantly higher in the PG-DTR group (100%) compared to the TG group (81.6%).

Conclusions:

• PG-DTR is associated with improved clinical outcomes and superior survival rates for upper EGC.
• The surgical approach demonstrated comparable complication and reflux rates to TG.
• PG-DTR may be a suitable and beneficial surgical option for selected patients with upper EGC.