Clinical Value Of Radical Proximal Gastrectomy Combined With Double Channel Anastomosis In Patients With Gastric Cancer

Objective:To investigate the clinical value of radical proximal gastrectomy combined with double channel anastomosis in patients with gastric cancer.Method:The clinical data of 90 patients with cardiac fundus malignant tumor admitted to the First Affiliated Hospital of Anhui Medical University from January 1,2018 to January 1,2019 were retrospectively analyzed.Among them,30 patients received radical proximal gastrectomy plus residual gastrojejunal double-channel anastomosis(double-channel group),30 patients received radical total gastrectomy plus Roux-en-Y anastomosis(total stomach group),and 30 patients received radical proximal gastrectomy plus esophageal residual stomach anastomosis(proximal stomach group).Postoperative complications,nutritional status and other indicators of the 3 groups were compared.The main outcome measure included:Clinical indicators observed in this study included:(1)preoperative general data: age,gender,preoperative complications,and TNM stage;(2)Preoperative nutritional indexes(serum levels of TP,Alb,PA,GS,HGB)were recorded in the three groups;(3)Postoperative nutritional indexes(serum levels of TP,Alb,PA,GS and HGB 12 months after surgery)were recorded in the three groups;(4)Postoperative reflux esophagitis(with or without acid reflux,heartburn,nausea,postprandial poststernal discomfort and upper digestive tract iodohydrography),postoperative anastomotic bleeding,postoperative anastomotic stenosis and other complications were recorded in the three groups.Result:The operative time of the double-channel group,the total gastric group and the proximal gastric group were(127.2 ± 35.6)min,(121.4 ± 45.7)min and(112.6±52.3)min,respectively.There was no statistical significance in operative time,anastomotic stenosis,incidence of anastomotic bleeding and preoperative nutritional status(preoperative serum total protein,albumin,pre-albumin,gastrin and hemoglobin)among the three groups.After the operation(12 months after the operation),there were statistically significant differences in serum total protein,albumin,prealbumin,gastrin and hemoglobin between the dual-channel group and the total stomach group,with P values less than 0.05(P values: 0.036,0.047,0.029,0.030,0.007,respectively).There were no significant differences in serum total protein,albumin,proalbumin,gastrin,and hemoglobin between the double-channel group and the proximal stomach group,with P values greater than 0.05(P values: 0.595,0.924,0.235,0.326,and 0.736,respectively).The incidence of postoperative reflux esophagitis was 30% in the proximal stomach group,while only 3.33% in the double-channel group.Conclusion:In conclusion,in the surgical treatment of early proximal gastric cancer,patients with proximal gastrectomy may have better postoperative nutritional status than those with total gastrectomy.In proximal gastrectomy,dual-channel anastomosis may reduce the incidence of postoperative reflux esophagitis compared with esophagogastric anastomosis.Radical proximal gastrectomy plus residual gastrojejunal dual-channel surgery may improve the nutritional status of patients after surgery and reduce the incidence of postoperative reflux esophagitis.