Clinical outcomes of double-flap technique versus gastric tube reconstruction following laparoscopic proximal gastrectomy: a multicenter propensity score-matched cohort study.

Abstract

Background: Various anti-reflux procedures are currently utilized for digestive tract reconstruction following proximal gastrectomy (PG), but the optimal reconstruction method remains debated. This study aims to compare and analyze the clinical outcomes and postoperative quality of life between double-flap technique (DFT) and gastric tube (GT) reconstruction after laparoscopic proximal gastrectomy (LPG), providing a reference for selecting the appropriate digestive tract reconstruction method.

Methods: This multicenter, retrospective cohort study employed propensity score matching (PSM) to address baseline imbalances. Clinical, pathological, and follow-up data were collected from 124 patients who underwent either LPG-GT or LPG-DFT between January 2016 and May 2023 at four medical centers in China. The surgical outcomes, incidence of postoperative gastroesophageal reflux and anastomotic stricture, postoperative nutritional status, and quality of life were compared between the two groups.

Results: After 1:1 PSM, 41 patients were included in each group for analysis. Compared to the LPG-GT group, the LPG-DFT group had a longer operation time (340.0 min vs. 280.0 min, P < 0.001) but less intraoperative blood loss (80.0 ml vs. 100.0 ml, P < 0.001), a shorter time to nasogastric tube removal (3.0 days vs. 5.0 days, P < 0.001), and shorter postoperative hospital stay (9.0 days vs. 12.0 days, P < 0.001). The incidence of gastroesophageal reflux in the LPG-DFT and LPG-GT groups was 7.3% and 24.3% (P = 0.034), respectively, and the incidence of anastomotic stricture requiring dilation was 14.6% and 7.3% (P = 0.480). One year postoperatively, BMI (22.0 kg/m² vs. 20.6 kg/m², P = 0.010) and albumin levels at six months postoperatively (41.6 g/L vs. 39.1 g/L, P = 0.033) were significantly higher in the LPG-DFT group. However, albumin levels one year postoperatively showed no significant difference between the two groups (42.3 g/L vs. 40.7 g/L, P = 0.226).

Conclusion: The surgical outcomes suggest that both LPG-GT and LPG-DFT are safe and feasible methods. However, LPG-DFT provides better anti-reflux effects and may help reduce the risk of postoperative malnutrition.