Remnant Stomach Influx Reduces Esophageal Reflux and Malnutrition After Proximal Gastrectomy With Double Tract...

Remnant stomach influx (RSI) from the anastomotic jejunal-remnant stomach, a physiological food passage, develops after proximal gastrectomy with double-tract reconstruction (PGDT). Sometimes, food passes into the jejunal-loop (JL). We investigated the association of the food passage route in PGDT (RSI/JL) with postoperative esophageal reflux and malnutrition.

We retrospectively collected data for 50 patients with upper-third gastric cancer and esophagogastric junction cancer with PGDT. Using one-year postoperative fluoroscopy findings, 40 propensity score-matched patients were classified into RSI and JL groups (n=20/group), respectively. The groups were comparatively evaluated for: clinicopathological characteristics [age, sex, body mass index (BMI), visceral fat index (VFI), subcutaneous fat index (SFI), skeletal muscle index, pathological stage]; perioperative factors [approach, postoperative complications ≥ Clavien-Dindo Grade 2, postoperative food passage); and esophageal reflux (reflux esophagitis frequency ≥ Grade A, degree of reflux based on fluoroscopy findings). Univariate and multivariate analysis identified predictive factors for post-operative malnutrition in all 50 patients.

After propensity score matching, grade of reflux esophagitis and degree of reflux was significantly lower (p=0.014, p<0.001) in the RSI versus JL group. The RSI group showed significantly attenuated percent decrease in BMI, VFI, and SFI (p=0.049, p=0.002, p=0.006). Multivariate analysis identified food passage route (JL) and pathological stage as predictive factors for postoperative malnutrition.

Postoperative esophageal reflux and malnutrition were attenuated by food passage mainly via the RSI after PGDT. Improved jejunal-remnant stomach is requisite to ensure satisfactory remnant stomach influx.