A Comparative Clinical Analysis of Esophagogastrostomy Versus Double-Tract Reconstruction Following Laparoscopic Proximal Gastrectomy

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Introduction Laparoscopic proximal gastrectomy (LPG) with esophagogastrostomy (EG) and double-tract reconstruction (DTR) for early gastric cancer of the upper stomach is a function-preserving surgery that retains oncological curative capability. However, direct comprehensive comparative analyses on the clinical outcomes of EG and DTR as reconstructive techniques following LPG are lacking. Therefore, this study investigated the short- and long-term clinical outcomes of EG and DTR following LPG.

Materials and Methods A retrospective comparative analysis was conducted based on a dataset compiled from two institutions. LPG cases for gastric cancer meeting eligibility criteria were divided into an EG group and a DTR group, and clinicopathological characteristics, perioperative outcomes, nutritional status, 3-year overall survival (OS), and cancer-specific survival (CSS) were analyzed. Furthermore, univariate and multivariate analyses were performed to identify risk factors for complications following LPG.

Result Among the 1198 patients, 104 received LPG, of whom 49 underwent EG and 41 underwent DTR. The DTR was significantly more frequently selected in patients with advanced cancer, while no significant differences were found in the other preoperative clinical factors. No significant differences were observed in perioperative outcomes, including postoperative complications, nutritional parameters, 3-year OS, and CSS. Multivariate analysis identified cardiac disease as a risk factor for postoperative complications following LPG.

Conclusion Short- and long-term clinical outcomes following LPG are equivalent between EG and DTR. For gastric cancer patients with cardiac disease undergoing LPG, careful attention is required for perioperative management.