Evaluation of combined tubular gastroesophageal anastomosis and C-shaped flap technique in proximal gastrectomy for gastric cancer: A retrospective propensity score matching analysis

Abstract

Background

Proximal gastrectomy (PG) is a functional-preserving surgical option for upper gastric and esophagogastric junction cancers. However, it is associated with a high risk of postoperative gastroesophageal reflux. This study evaluates the safety and effectiveness of combining tubular gastroesophageal (TG) anastomosis with a C-shaped single muscle flap technique to enhance anti-reflux function.

Methods

A retrospective study was conducted on patients who underwent laparoscopic PG at Northern Jiangsu People's Hospital between June 2021 and June 2024. Patients were divided into two groups: TG alone and TG combined with a C-shaped single muscle flap. Propensity score matching (PSM) was applied in a 1:2 ratio to balance baseline characteristics. Clinical outcomes, postoperative complications, and quality of life assessments using the PGSAS-45 questionnaire were analyzed.

Results

After PSM, 24 patients in the combined group and 48 in the TG group were analyzed. Operative time was significantly longer in the combined group (p < 0.001), but no significant differences were found in intraoperative blood loss, postoperative hospital stay, or complications (p > 0.05). The combined group had a significantly lower incidence of gastroesophageal reflux symptoms, with better scores for esophageal reflux (p = 0.004), dissatisfaction with symptoms (p < 0.001), and dissatisfaction at meals (p = 0.001) compared to the TG group.

Conclusion

The combination of TG with a C-shaped single muscle flap significantly reduces postoperative reflux symptoms while maintaining surgical safety. Although it prolongs operative time, the technique provides an effective anti-reflux mechanism and improves postoperative quality of life.