Robotic-assisted proximal gastrectomy with right-sided overlap and single-flap valvuloplasty

The incidence of proximal gastric cancer is increasing. Traditional total gastrectomy compromises nutritional status, while proximal gastrectomy increases the risk of gastroesophageal reflux disease (GERD). To address the reflux issues associated with proximal gastrectomy, robotic-assisted right-sided overlap single-flap valvuloplasty (ROSF) has been developed to overcome the technical challenges of anti-reflux anastomosis. This study evaluates the safety, feasibility, and anti-reflux efficacy of ROSF.

A descriptive case series included 20 patients undergoing robotic-assisted proximal gastrectomy with ROSF for Siewert II/III tumors between April 2023 and April 2024. Outcomes included operative metrics, complications (Clavien-Dindo classification), reflux severity assessed by the GERD scale and Los Angeles classification, and follow-up data.

All procedures were completed robotically without conversion. One anastomotic stricture (5.0%) occurred and was resolved with endoscopic dilation. No reflux esophagitis, anastomotic leaks, or postoperative mortality occurred. The mean lymph node yield was 31 ± 6.8, with 14.7 ± 4.3 nodes harvested from the superior margin of the pancreas. GERD scores comparing preoperative (2.4 ± 1.0) and 6-month postoperative (2.7 ± 0.6; P = 0.148) values showed no significant worsening. Endoscopy confirmed intact anastomoses and normal mucosa at the anastomotic site.

Robotic-assisted ROSF is a safe and effective technique for proximal gastrectomy, minimizing reflux and anastomotic complications. Robotic-assisted ROSF is a safe and effective technique for proximal gastrectomy, with favorable short-term outcomes in terms of technical feasibility, anastomotic safety, reflux control, and short-term nutritional stability. Its technical precision in anti-reflux reconstruction and simplified workflow support broader adoption.