The clinical outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction versus tube-like stomach reconstruction in patients with adenocarcinoma of the esophagogastric junction based on propensity score-matching: a multicenter cohort study

Frontiers in Oncology

Oncology

Su Yan¹  Kang Zhao¹  Hexin Lin²  Zhiwen Xu³  Jun You³  Qingqi Hong³  Wei Lin⁴  Huibin Liu⁴  Changyue Zheng⁴  Zhihua Chen⁵  Shaoqin Chen⁵  Yongan Fu⁶  Jinping Chen⁶ 

[1] Department of Gastrointestinal Oncology Surgery, the Affiliated Hospital of Qinghai University, Xining, China;Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital of Xiamen University, Xiamen, China;Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital of Xiamen University, Xiamen, China;School of Medicine, Xiamen University, Xiamen, China;Department of Gastrointestinal Surgery, the Affiliated Hospital of Putian College, Putian, China;Department of Gastrointestinal Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China;Department of Gastrointestinal Surgery, the First Hospital of Quanzhou, Quanzhou, China;

关键词: adenocarcinoma of the esophagogastric junction;    proximal gastrectomy;    digestive tract reconstruction;    double-tract reconstruction;    tube-like stomach reconstruction;    quality of life;   

DOI  :  10.3389/fonc.2023.1137836

 received in 2023-01-04, accepted in 2023-05-24,  发布年份 2023

来源: Frontiers

【 摘 要 】

PurposeLaparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic proximal gastrectomy with tube-like stomach reconstruction (LPG-TLR) are both function-preserving procedures performed for treating AEG. However, there is no clinical consensus on the selection of digestive tract reconstruction after proximal gastrectomy, and the best way to reconstruct the digestive tract remains controversial. This study aimed at comparing the clinical outcomes of LPG-DTR and LPG-TLR to provide some reference to the choice of AEG surgical modalities.MethodsThis was a multicenter, retrospective cohort study. we collected clinicopathological and follow-up data of patients with consecutive cases diagnosed with AEG from January 2016 to June 2021 in five medical centers. According to the way of digestive tract reconstruction after tumor resection, patients who underwent LPG-DTR or LPG-TLR were included in the present study. Propensity score matching (PSM) was performed to balance baseline variables that might affect the study outcomes. The QOL of the patients was evaluated using the Visick grade.ResultsA total of 124 eligible consecutive cases were finally included. Patients in both groups were matched using the PSM method, and 55 patients from each group were included in the analysis after PSM. There was no statistically significant difference between the two groups in terms of the operation time, amount of intraoperative blood loss, days of postoperative abdominal drainage tube placement, postoperative hospitalization days, total hospitalization cost, the total number of lymph nodes cleared, and the number of positive lymph nodes (P>0.05). There was a statistically significant difference between the two groups in terms of time to first flatus after surgery and postoperative soft food recovery time (P<0.05). For the nutritional status, the weight levels at 1 year after surgery was better in the LPG-DTR group than in the LPG-TLR group (P<0.05). There was no significant difference in Visick grade between the two groups (P>0.05).ConclusionThe anti-reflux effect and quality of life of LPG-DTR for AEG were comparable to those of LPG-TLR. Compared with LPG-TLR, LPG-DTR provide better nutrition status for patients with AEG. LPG-DTR is a superior reconstruction method after proximal gastrectomy.

【 授权许可】

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Copyright © 2023 Xu, Chen, Chen, Lin, Zhao, Zheng, Liu, Chen, Fu, Hong, Lin, Yan and You