[Digestive tract reconstruction after proximal gastrectomy-current applications and future perspectives of...

In recent years, proximal gastrectomy (PG) has attracted increasing attention because it enables radical tumor resection while preserving gastric function and improving nutritional status and quality of life. However, how to effectively prevent reflux and anastomotic stricture during reconstruction remains a key challenge in functional reconstruction. This review summarizes the main types of gastroesophageal anastomosis after PG and categorizes the major reconstructive concepts into two groups. The first is the "residual stomach reshaping" approach, which rebuilds the anti-reflux structure by altering the morphology of the remnant stomach. Representative techniques include tubular gastroesophageal anastomosis (TGA), transverse fan-shaped dam formation, and the "GIRAFFE" reconstruction. The second is the "cardia reconstruction" approach, which creates a unidirectional valve-like high-pressure zone using seromuscular or muscular flaps. Representative procedures include the double-flap technique (DFT), single-flap technique (SFT), and tunnel method. TGA features a simple structure and easy manipulation but provides limited anti-reflux capacity. Transverse fan-shaped groin formed adds a "valve-like folding structure" to enhance barrier function. The GIRAFFE reconstruction achieves a balance between anti-reflux function and gastric emptying based on His angle remodeling and gastric pouch formation. Flap-based procedures simulate the physiological cardia structure to establish a high-pressure zone, among which DFT is supported by the most substantial evidence. SFT is characterized by simplified operation and a lower risk of stricture, while the tunnel method shows potential in balancing blood supply and anti-reflux efficacy. In the future, integrating the concepts of "residual stomach reshaping" and "cardia reconstruction", combined with robotic and minimally invasive technologies to achieve precise and standardized operations, will represent an important direction for the advancement of functional PG.