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Technical variety of anastomotic techniques used in proximal gastrectomy with double-tract-reconstruction - a narrative review

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Abstract

In the past 40 years, the incidence of esophagogastric junction cancer has been gradually increasing worldwide. Currently, surgical resection remains the main radical treatment for early gastric cancer. Due to the rise of functional preservation surgery, proximal gastrectomy has become an alternative to total gastrectomy for surgeons in Japan and South Korea. However, the methods of digestive tract reconstruction after proximal gastrectomy have not been fully unified. At present, the principal methods include esophagogastrostomy, double flap technique, jejunal interposition, and double tract reconstruction. Related studies have shown that double tract reconstruction has a good anti-reflux effect and improves postoperative nutritional prognosis, and it is expected to become a standard digestive tract reconstruction method after proximal gastrectomy. However, the optimal anastomoses mode in current double tract reconstruction is still controversial. This article aims to review the current status of double tract reconstruction and address the aforementioned issues.

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References

  1. (2020) Erratum: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 70(4):313. https://doi.org/10.3322/caac.21609

  2. Sung H, Ferlay J, Siegel RL et al (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71(3):209–249. https://doi.org/10.3322/caac.21660

    Article  CAS  PubMed  Google Scholar 

  3. Kusano C, Gotoda T, Khor CJ et al (2008) Changing trends in the proportion of adenocarcinoma of the EGJ in a large tertiary referral center in Japan. J Gastroenterol Hepatol 23(11):1662–1665. https://doi.org/10.1111/j.1440-1746.2008.05572.x

    Article  PubMed  Google Scholar 

  4. Liu K, Yang K, Zhang W et al (2016) Changes of Esophagogastric Junctional Adenocarcinoma and Gastroesophageal Reflux Disease Among Surgical Patients During 1988-2012: A Single-institution, High-volume Experience in China. Ann Surg 263(1):88–95. https://doi.org/10.1097/SLA.0000000000001148

    Article  PubMed  Google Scholar 

  5. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24(1):1–21. https://doi.org/10.1007/s10120-020-01042-y

    Article  Google Scholar 

  6. Rosa F, Quero G, Fiorillo C et al (2018) Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer-GIRCG). Gastric Cancer 21(5):845–852. https://doi.org/10.1007/s10120-018-0804-3

    Article  PubMed  Google Scholar 

  7. Aikou T, Natsugoe S, Shimazu H, Nishi M (1988) Antrum preserving double tract method for reconstruction following proximal gastrectomy. Jpn J Surg 18(1):114–115. https://doi.org/10.1007/BF02470857

    Article  CAS  PubMed  Google Scholar 

  8. Wen L, Chen XZ, Wu B et al (2012) Total vs. proximal gastrectomy for proximal gastric cancer: a systematic review and meta-analysis. Hepatogastroenterology 59(114):633–640. https://doi.org/10.5754/hge11834

    Article  PubMed  Google Scholar 

  9. Hwang SH, Park DJ, Kim HH et al (2022) Short-Term Outcomes of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction Versus Laparoscopic Total Gastrectomy for Upper Early Gastric Cancer: A KLASS 05 Randomized Clinical Trial. J Gastric Cancer 22(2):94–106. https://doi.org/10.5230/jgc.2022.22.e8

    Article  PubMed  PubMed Central  Google Scholar 

  10. Park DJ, Han SU, Hyung WJ et al (2023) Effect of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction vs Total Gastrectomy on Hemoglobin Level and Vitamin B12 Supplementation in Upper-Third Early Gastric Cancer: A Randomized Clinical Trial. JAMA Netw Open 6(2):e2256004. Published 2023 Feb 1. https://doi.org/10.1001/jamasimiliarrkopen.2022.56004

    Article  PubMed  PubMed Central  Google Scholar 

  11. Sato R, Kinoshita T, Akimoto E, Yoshida M, Nishiguchi Y, Harada J (2021) Feasibility and quality of life assessment of laparoscopic proximal gastrectomy using double-tract reconstruction. Langenbecks Arch Surg 406(2):479–489. https://doi.org/10.1007/s00423-020-02076-7

    Article  PubMed  Google Scholar 

  12. Wang L, Xia Y, Jiang T et al (2020) Short-Term Surgical Outcomes of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction Versus Laparoscopic Total Gastrectomy for Adenocarcinoma of EGJ: A Matched-Cohort Study. J Surg Res 246:292–299. https://doi.org/10.1016/j.jss.2019.09.022

    Article  CAS  PubMed  Google Scholar 

  13. Nomura E, Kayano H, Lee SW et al (2019) Functional evaluations comparing the double-tract method and the jejunal interposition method following laparoscopic proximal gastrectomy for gastric cancer: an investigation including laparoscopic total gastrectomy. Surg Today 49(1):38–48. https://doi.org/10.1007/s00595-018-1699-7

    Article  CAS  PubMed  Google Scholar 

  14. Xu Y, Tan Y, Wang Y, Xi C, Ye N, Xu X (2019) Proximal versus total gastrectomy for proximal early gastric cancer: A systematic review and meta-analysis. Medicine (Baltimore) 98(19):e15663. https://doi.org/10.1097/MD.0000000000015663

    Article  PubMed  Google Scholar 

  15. Xu Y, Gao J, Wang Y et al (2020) Validation of a novel reconstruction method of laparoscopic gastrectomy for proximal early gastric cancer: a systematic review and meta-analysis. World J Surg Oncol 18(1):214. Published 2020 Aug 18. https://doi.org/10.1186/s12957-020-01993-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Li Z, Dong J, Huang Q (2023) Feasibility of laparoscopic proximal gastrectomy with piggyback jejunal interposition double-tract reconstruction for proximal gastric cancer: A propensity score-matching analysis. J Minim Access Surg 19(1):20–27. https://doi.org/10.4103/jmas.jmas_46_22

    Article  PubMed  Google Scholar 

  17. Park JY, Park KB, Kwon OK, Yu W (2018) Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy in terms of nutritional status or quality of life in early gastric cancer patients. Eur J Surg Oncol 44(12):1963–1970. https://doi.org/10.1016/j.ejso.2018.08.014

    Article  PubMed  Google Scholar 

  18. Yang L, Wu JZ, You J et al (2022) Zhonghua Wai Ke Za Zhi 60(9):838–845. https://doi.org/10.3760/cma.j.cn112139-20220418-00175

    Article  CAS  PubMed  Google Scholar 

  19. Eom BW, Park JY, Park KB et al (2021) Comparison of nutrition and quality of life of esophagogastrostomy and the double-tract reconstruction after laparoscopic proximal gastrectomy. Medicine (Baltimore) 100(15):e25453. https://doi.org/10.1097/MD.0000000000025453

    Article  CAS  PubMed  Google Scholar 

  20. Cho M, Son T, Kim HI et al (2019) Similar hematologic and nutritional outcomes after proximal gastrectomy with double-tract reconstruction in comparison to total gastrectomy for early upper gastric cancer. Surg Endosc 33(6):1757–1768. https://doi.org/10.1007/s00464-018-6448-x

    Article  PubMed  Google Scholar 

  21. Kim HI, Cho I, Jang DS, Hyung WJ (2013) Intracorporeal esophagojejunostomy using a circular stapler with a new purse-string suture technique during laparoscopic total gastrectomy. J Am Coll Surg 216(2):e11–e16. https://doi.org/10.1016/j.jamcollsurg.2012.10.008

    Article  PubMed  Google Scholar 

  22. Omori T, Oyama T, Mizutani S et al (2009) A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg 197(1):e13–e17. https://doi.org/10.1016/j.amjsurg.2008.04.019

    Article  PubMed  Google Scholar 

  23. Nomura E, Kayano H, Seki T et al (2021) Preventive procedure for stenosis after esophagojejunostomy using a circular stapler and transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy and total gastrectomy involving reduction of anastomotic tension. BMC Surg 21(1):47. Published 2021 Jan 21. https://doi.org/10.1186/s12893-021-01054-0

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hong F, Wang Y, Zhang Y et al (2021) Comparison of the short-term outcomes of laparoscopic and open total or proximal gastrectomy using the transorally inserted anvil (OrVilTM) for the proximal reconstruction: a propensity score matching analysis. Langenbecks Arch Surg 406(3):651–658. https://doi.org/10.1007/s00423-021-02126-8

    Article  PubMed  Google Scholar 

  25. Jeong O, Park YK (2009) Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc 23(11):2624–2630. https://doi.org/10.1007/s00464-009-0461-z

    Article  PubMed  Google Scholar 

  26. Inaba K, Satoh S, Ishida Y et al (2010) Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg 211(6):e25–e29. https://doi.org/10.1016/j.jamcollsurg.2010.09.005

    Article  PubMed  Google Scholar 

  27. Kim HS, Kim BS, Lee S, Lee IS, Yook JH, Kim BS (2013) Reconstruction of esophagojejunostomies using endoscopic linear staplers in totally laparoscopic total gastrectomy: report of 139 cases in a large-volume center. Surg Laparosc Endosc Percutan Tech 23(6):e209–e216. https://doi.org/10.1097/SLE.0b013e31828e3b79

    Article  PubMed  Google Scholar 

  28. Huang ZN, Huang CM, Zheng CH et al (2017) Digestive tract reconstruction using isoperistaltic jejunum-later-cut overlap method after totally laparoscopic total gastrectomy for gastric cancer: Short-term outcomes and impact on quality of life. World J Gastroenterol 23(39):7129–7138. https://doi.org/10.3748/wjg.v23.i39.7129

    Article  PubMed  PubMed Central  Google Scholar 

  29. Sun KK, Wang Z, Peng W et al (2021) Esophagus two-step-cut overlap method in esophagojejunostomy after laparoscopic gastrectomy. Langenbecks Arch Surg 406(2):497–502. https://doi.org/10.1007/s00423-021-02079-y

    Article  PubMed  Google Scholar 

  30. Kwon IG, Son YG, Ryu SW (2016) Novel Intracorporeal Esophagojejunostomy Using Linear Staplers During Laparoscopic Total Gastrectomy: π-Shaped Esophagojejunostomy, 3-in-1 Technique. J Am Coll Surg 223(3):e25–e29. https://doi.org/10.1016/j.jamcollsurg.2016.06.011

    Article  PubMed  Google Scholar 

  31. Zhang S, Khaliq J, Li D, Jiang X, Sun R, Li Y (2018) Robotic total gastrectomy with π-shaped esophagojejunostomy using a linear stapler as a novel technique. World J Surg Oncol 16(1):238. Published 2018 Dec 21. https://doi.org/10.1186/s12957-018-1542-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Zhang S, Li D, Wang Y et al (2021) A novel method for π-shaped esophagojejunostomy and double-tract reconstruction (DTR) as an alternative in totally laparoscopic or robotic proximal gastrectomy for treating upper third proximal early gastric cancer. Updates Surg 73(2):597–605. https://doi.org/10.1007/s13304-021-00993-w

    Article  PubMed  Google Scholar 

  33. Li X, Gong S, Lu T et al (2022) Proximal Gastrectomy Versus Total Gastrectomy for Siewert II/III Adenocarcinoma of the Gastroesophageal Junction: a Systematic Review and Meta-analysis. J Gastrointest Surg 26(6):1321–1335. https://doi.org/10.1007/s11605-022-05304-1

    Article  PubMed  Google Scholar 

  34. Choi NR, Choi MH, Ko CS, Lee I, Gong CS, Kim BS (2020) Totally laparoscopic proximal gastrectomy with double tract reconstruction: outcomes of 37 consecutive cases. Wideochir Inne Tech Maloinwazyjne 15(3):446–454. https://doi.org/10.5114/wiitm.2020.94154

    Article  PubMed  PubMed Central  Google Scholar 

  35. Hölscher A, Berlth F, Hemmerich M, Minot S, Schmidt H (2020) Double-Tract-Rekonstruktion nach Resektion des gastroösophagealen Übergangs wegen AEG-II- und -III-Tumoren [Double Tract Reconstruction Following Limited Oesophagogastric Resection of AEG Types II and III Adenocarcinomas]. Zentralbl Chir 145(1):35–40. https://doi.org/10.1055/a-0882-6490

    Article  PubMed  Google Scholar 

  36. Hölscher AH, Law S (2020) Correction to: EGJ adenocarcinomas: individualization of resection with special considerations for Siewert type II, and Nishi types EG, E = G and GE cancers. Gastric Cancer 23(1):10. https://doi.org/10.1007/s10120-019-01032-9

    Article  CAS  PubMed  Google Scholar 

  37. Tan L, Ran MN, Liu ZL et al (2022) Comparison of the prognosis of four different surgical strategies for proximal gastric cancer: a network meta-analysis. Langenbecks Arch Surg 407(1):63–74. https://doi.org/10.1007/s00423-021-02378-4

    Article  PubMed  Google Scholar 

  38. Lee I, Oh Y, Park SH, Kwon Y, Park S (2020) Postoperative nutritional outcomes and quality of life-related complications of proximal versus total gastrectomy for upper-third early gastric cancer: a meta-analysis. Sci Rep 10(1):21460. https://doi.org/10.1038/s41598-020-78458-0

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Yue C, Peng R, Wei W et al (2020) Comparison on the Efficacy of Double Tract Gastric Interposition Reconstruction Versus Jejunal Interposition Reconstruction After Proximal Gastrectomy. Med Sci Monit 26:e922504. Published 2020 Jul 6. https://doi.org/10.12659/MSM.922504

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hu J, Zhao L, Xue H, Zhang Z, Du J (2020) Predominant classic circular-stapled double-tract reconstruction after totally laparoscopic proximal gastrectomy: safe, feasible, time-saving anastomoses by technical tie-up. Surg Endosc 34(11):5181–5187. https://doi.org/10.1007/s00464-020-07824-w

    Article  PubMed  Google Scholar 

  41. Du J, Xue H, Hua J, Zhao L, Zhang Z (2019) Intracorporeal classic circular-stapled gastrojejunostomy and jejunojejunostomy during laparoscopic distal gastrectomy: A simple, safe "intraluminal poke technique" for anvil placement. J Surg Oncol 119(4):464–471. https://doi.org/10.1002/jso.25353

    Article  PubMed  Google Scholar 

  42. Aburatani T, Kojima K, Otsuki S et al (2017) Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD. Surg Endosc 31(11):4848–4856. https://doi.org/10.1007/s00464-017-5539-4

    Article  PubMed  Google Scholar 

  43. Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH (2014) Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric Cancer 17(3):562–570. https://doi.org/10.1007/s10120-013-0303-5

    Article  PubMed  Google Scholar 

  44. Kamiya S, Namikawa T, Takahashi M et al (2022) Optimal Procedures for Double Tract Reconstruction After Proximal Gastrectomy Assessed by Postgastrectomy Syndrome Assessment Scale-45. J Gastrointest Surg 26(9):1817–1829. https://doi.org/10.1007/s11605-022-05328-7

    Article  PubMed  Google Scholar 

  45. Fujimoto D, Taniguchi K, Kobayashi H (2020) Double-Tract Reconstruction Designed to Allow More Food Flow to the Remnant Stomach After Laparoscopic Proximal Gastrectomy. World J Surg 44(8):2728–2735. https://doi.org/10.1007/s00268-020-05496-0

    Article  PubMed  Google Scholar 

  46. Ojima T, Nakamori M, Nakamura M et al (2018) Fundoplication with 180-Degree Wrap During Esophagogastrostomy After Robotic Proximal Gastrectomy for Early Gastric Cancer. J Gastrointest Surg 22(8):1475–1476. https://doi.org/10.1007/s11605-018-3765-2

    Article  PubMed  Google Scholar 

  47. Tanimura S, Higashino M, Fukunaga Y, Osugi H (2003) Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Gastric Cancer 6(1):64–68. https://doi.org/10.1007/s101200300009

    Article  PubMed  Google Scholar 

  48. Orthopoulos G, Grant HM, Sharma P, Thompson E, Romanelli JR (2020) S054: incidence and management of jejunojejunal intussusception after Roux-en-Y gastric bypass: a large case series. Surg Endosc 34(5):2204–2210. https://doi.org/10.1007/s00464-019-07009-0

    Article  PubMed  Google Scholar 

  49. Lu S, Ma F, Yang W, Peng L, Hua Y (2023) Is single tract jejunal interposition better than double tract reconstruction after proximal gastrectomy? Updates Surg 75(1):53–63. https://doi.org/10.1007/s13304-022-01393-4

    Article  PubMed  Google Scholar 

  50. Nomura E, Lee SW, Kawai M et al (2014) Functional outcomes by reconstruction technique following laparoscopic proximal gastrectomy for gastric cancer: double tract versus jejunal interposition. World J Surg Oncol 12:20. Published 2014 Jan 27. https://doi.org/10.1186/1477-7819-12-20

    Article  PubMed  PubMed Central  Google Scholar 

  51. Yin M, Wang Y, Han M et al (2023) Mechanisms of bariatric surgery for weight loss and diabetes remission. J Diabetes 15(9):736–752. https://doi.org/10.1111/1753-0407.13443

    Article  PubMed  PubMed Central  Google Scholar 

  52. Yamashita H, Toyota K, Kunisaki C et al (2022) Current status of selecting type of gastrectomy and reconstruction for patients with proximal gastric cancer in Japan [published online ahead of print, 2022 Dec 1]. Asian J Surg. https://doi.org/10.1016/j.asjsur.2022.11.069

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Funding

This work was supported by National Natural Science Foundation of China grant number: 82002775.

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  1. Department of general surgery, Zhujiang Hospital, Southern Medical University, Guangdong Province, 510282, China

    Hai-Peng Tang, He-Xi Zhu, Guo-Peng Lu, Zheng-Qi Peng, Ze-Kai Chen & Meng-Chuan Wang

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Hai-Peng Tang and He-Xi Zhu: study design, literature research and manuscript preparation. Guo-Peng Lu, Zheng-Qi Peng and Ze-Kai Chen: study design, literature research and manuscript review. Meng-Chuan Wang: guarantor of integrity of the entire study, study design, and manuscript review. All authors approved the version to be published.

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Tang, HP., Zhu, HX., Lu, GP. et al. Technical variety of anastomotic techniques used in proximal gastrectomy with double-tract-reconstruction - a narrative review. Langenbecks Arch Surg 409, 148 (2024). https://doi.org/10.1007/s00423-024-03339-3

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