The comparison of post-proximal gastrectomy digestive tract reconstruction methods

Area of Science:

• Gastroenterology and Surgical Oncology
• Digestive Tract Reconstruction
• Gastric Cancer Surgery

Background:

• Proximal gastrectomy (PG) for gastric cancer necessitates digestive tract reconstruction due to gastroesophageal reflux.
• Common reconstruction methods include esophagogastrostomy (EG), jejunal interposition (JI), and double tract reconstruction (DTR).
• Evaluating the comparative effectiveness of these reconstruction techniques is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the efficacy of esophagogastrostomy (EG), jejunal interposition (JI), and double tract reconstruction (DTR) following proximal gastrectomy (PG).
• To assess the impact of different reconstruction methods on preventing gastroesophageal reflux and improving patient quality of life.

Main Methods:

• Retrospective analysis of clinical data from 94 patients undergoing PG with EG (37), JI (29), or DTR (28).
• Evaluation of safety and surgical complications using Reflux Symptom Index (RSI), GERD-Q scores, gastroscopy, barium meal, and 24-h pH monitoring.
• Quality of life assessed using the EORTC QLQ-STO22 questionnaire.

Main Results:

• Double tract reconstruction (DTR) group demonstrated significantly lower GERD-Q and RSI scores compared to EG and JI groups (p < 0.05), indicating superior reflux prevention.
• All groups showed reduced GERD-Q scores post-surgery, with DTR exhibiting the most significant improvement (p < 0.05).
• The DTR group reported higher overall health status scores on the EORTC QLQ-STO22 questionnaire (p < 0.001).

Conclusions:

• While EG offers shorter surgical duration and less bleeding, and JI reduces reflux esophagitis prevalence.
• Double tract reconstruction (DTR) provides superior prevention of reflux esophagitis.
• DTR significantly enhances the quality of life for patients following proximal gastrectomy.