Double tract reconstruction in proximal gastric tumors: A systematic review of clinical and functional outcomes.

Background: Proximal gastrectomy (PG) with double tract reconstruction (DTR) has recently emerged as a function-preserving alternative to total gastrectomy (TG) with Roux-en-Y (RNY) reconstruction in patients with proximally located gastric cancer.

Aim: To evaluate the current evidence comparing PG-DTR with TG-RNY in terms of perioperative outcomes, long-term survival, complication rates, nutritional status and reflux esophagitis.

Methods: A systematic literature search was conducted using PubMed, MEDLINE, Web of Science and the Cochrane Library for studies published between 2010 and January 2025. Search terms included gastric cancer, DTR and TG. Trials comparing PG-DTR with TG-RNY or PG-esophagogastrostomy (EG) were included. Data on operative details, lymph node yield, complications (Clavien-Dindo ≥ III), nutritional markers and incidence of reflux were extracted. Nineteen trials met the inclusion criteria. The review followed the PRISMA guidelines.

Results: PG-DTR was found to have comparable long-term oncological outcomes to TG-RNY, despite a lower extent of lymph node dissection. Operative time and intraoperative blood loss were generally similar, with some studies favouring PG-DTR. Rates of major postoperative complications were comparable between techniques. Notably, PG-DTR showed a significantly lower incidence of reflux esophagitis than PG-EG and was comparable or superior to TG-RNY in reflux control. Nutritionally, PG-DTR was associated with better post-operative weight maintenance and biochemical parameters such as haemoglobin, albumin and vitamin B12 levels compared to TG-RNY. No significant nutritional differences were observed between PG-DTR and PG-EG. PG-DTR appears to offer a balanced approach to the surgical treatment of proximal gastric cancer, combining oncological safety with functional and nutritional benefits.

Conclusion: Its superiority over TG-RNY in postoperative nutrition and reflux prevention, together with comparable complication rates and survival, supports its consideration as a preferred reconstruction method in selected patients.