Short-term outcomes and quality of life of esophagogastrostomy versus the double-tract reconstruction after laparoscopic proximal gastrectomy

• Published in: BMC cancer 2024-10, Vol.24 (1), p.1324-9, Article 1324
• Main Authors: Sun, Yong, Chen, Chao, Hou, Lei, Zhao, Enhong
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Adenocarcinoma - surgery; Aged; Albumin; Appetite loss; Body mass index; Cancer therapies; Care and treatment; Clinical medicine; Complications; Complications and side effects; Diagnosis; Double-tract reconstruction; Esophagitis; Esophagogastric Junction - pathology; Esophagogastric Junction - surgery; Esophagogastrostomy; Esophagus; Female; Gastrectomy; Gastrectomy - adverse effects; Gastrectomy - methods; Gastric cancer; Gastrointestinal cancer; Gastrointestinal surgery; Gastrostomy - adverse effects; Gastrostomy - methods; Health aspects; Hemoglobin; Hospitals; Humans; Infections; Laparoscopic proximal gastrectomy; Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Lymph nodes; Male; Middle Aged; Nutritional status; Patient outcomes; Patients; Plastic Surgery Procedures - adverse effects; Plastic Surgery Procedures - methods; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Prevention; Public health; Quality of Life; Questionnaires; Reconstructive surgery; Regression analysis; Retrospective Studies; Risk factors; Short-term outcome; Small intestine; Statistical analysis; Stomach; Stomach Neoplasms - surgery; Surgeons; Surgical anastomosis; Surgical outcomes; Sutures; Treatment Outcome
• ISSN: 1471-2407; 1471-2407
• DOI: 10.1186/s12885-024-13095-8

There is no optimal reconstruction technique after proximal gastrectomy. The esophagogastrostomy (EG) is a rather simple procedure technically, but the incidences of reflux esophagitis and anastomotic stricture are higher. While the double-tract reconstruction (DTR) can lessen postoperative reflux esophagitis, it is technically complex with a long operation time. The purpose of this study was to evaluate the quality of life (QoL) and short-term outcomes of the two reconstruction techniques. We retrospectively collected consecutive patients with upper-third gastric adenocarcinoma and adenocarcinoma of the esophagogastric junction (AEG) at our center between 2019 June and 2023 May. Patients who underwent laparoscopic proximal gastrectomy (LPG) with EG or DTR were included in this study. A comparison was made between the clinical and pathological characteristics of patients and their surgical parameters, postoperative complications, and its 1-year QoL in two groups. The QoL of the two groups was assessed by Visick grading, the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and EORTC QLQ-STO22 scales at 1 year after operation. The nutritional status of the two groups was evaluated by BMI, hemoglobin and serum albumin. AII the qualified patients were divided EG group (n = 63) and DTR group (n = 93). Compared to the DTR group, the blood loss volume of EG group was more (p = 0.001). There were no significant differences in operation duration, number of lymph nodes dissected, and postoperative length of stay between the two groups(p > 0.05). No statistical differences were observed in terms of the incidence of early complications and Clavien-Dindo classification as well(p > 0.05). After one year, the Visick grade of the DTR group was better than EG group (p = 0.040). The multivariable logistic regression analysis showed the only independent risk factor for reflux esophagitis was the reconstruction method. According to the EORTC QLQ-C30 questionnaire, patients in the DTR group had a better global health status(p = 0.001) and complained less about nausea and vomiting(p = 0.033), and appetite loss (p = 0.022). Patients in the DTR group complained less about reflux (p = 0.030) based on the EORTC QLQ-STO22 questionnaire. The multiple linear regression analysis revealed that the reconstruction method, reflux esophagitis and age had a linear relationship with the global health status score. Regarding nutritional status, BMI of the two groups b