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Double tract reconstruction versus double flap technique: short-term clinical outcomes after laparoscopic proximal gastrectomy for early gastric cancer

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Abstract

Background

Laparoscopic proximal gastrectomy (LPG) is increasingly preferred for operative management of early gastric cancer, although there is no consensus on a standard reconstruction method after resection. Two popular methods used after LPG are double tract reconstruction (DTR) and double flap technique (DFT). This study assessed comprehensive clinical outcomes including quality of life (QoL) and body composition change 1 year after DFT and DTR.

Methods

We retrospectively reviewed prospectively collected data from 51 to 18 patients who underwent DTR and DFT, respectively, between September 2014 and December 2018. Short-term surgical outcomes, presence of reflux esophagitis, nutritional supplementation, medications, nutritional status (laboratory results and body composition analysis), and QoL measured preoperatively and at 1 year postoperatively were compared between both groups.

Results

Both groups did not differ significantly in clinicopathological characteristics. The DFT as compared to the DTR group required significantly longer time for anastomosis (79.4 vs. 60.9 min, p < 0.001) and use of fewer staplers (3.39 vs. 6.86, p < 0.001). While the presence of endoscopic reflux esophagitis and iron/vitamin B12 replacement were comparable, the DTR group showed a higher tendency of taking anti-reflux medications for reflux symptoms (DTR: 13.7% vs. DFT: 0.0%, p = 0.177). The DTR group lost significantly more weight (p = 0.038) and body fat (p = 0.009). QoL analysis showed significant deterioration in diarrhea, eating restriction, and taste problems in both groups (DTR group: p = 0.008, p < 0.001, p = 0.010, respectively, and DFT group: p = 0.017, p = 0.024, p = 0.034, respectively). However, only the DTR group showed significant deterioration in physical function (p = 0.009), role function (p = 0.033), nausea/vomiting (p = 0.041), appetite loss (p = 0.019), dysphagia (p = 0.001), pain (p = 0.025), and body image (p = 0.004).

Conclusions

Despite requiring a longer anastomosis time, performing DFT after LPG was shown to be an ideal reconstruction method in terms of better 1-year QoL and nutritional outcome. Further larger studies over longer postoperative periods are necessary to confirm our findings.

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Funding

The authors declare they have no funding.

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Authors and Affiliations

  1. Intensive Care Unit, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

    Byunghyuk Yu

  2. School of Medicine, Kyungpook National University, Daegu, Republic of Korea

    Byunghyuk Yu

  3. Gastric Cancer Center, Kyungpook National University Chilgok Hospital, 807 Hoguk-ro, Daegu, 41404, Republic of Korea

    Ki Bum Park, Ji Yeon Park & Oh Kyoung Kwon

  4. Department of Surgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea

    Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Oh Kyoung Kwon, Ho Young Chung & Yoon Jin Hwang

  5. Department of Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea

    Seung Soo Lee & Ho Young Chung

  6. Hepatobiliary-Pancreatic Center, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea

    Yoon Jin Hwang

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  1. Byunghyuk Yu
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Correspondence to Oh Kyoung Kwon.

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Drs. Byunghyuk Yu, Ki Bum Park, Ji Yeon Park, Seung Soo Lee, Oh Kyoung Kwon, Ho Young Chung, and Yoon Jin Hwang have no conflicts of interest or financial ties to disclose.

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Yu, B., Park, K.B., Park, J.Y. et al. Double tract reconstruction versus double flap technique: short-term clinical outcomes after laparoscopic proximal gastrectomy for early gastric cancer. Surg Endosc 36, 5243–5256 (2022). https://doi.org/10.1007/s00464-021-08902-3

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