The Clinical Effect Of Tubular Esophagogastric Anastomosis In Laparoscopic Radical Proximal Gastrectomy For Upper Gastric Cancer

Objective:To evaluate the application safety and clinical efficacy of tubular esophagogastric anastomosis in laparoscopic radical proximal gastrectomy for upper gastric cancer,and to discuss the clinical value and significance of indocyanine green fluorescence tracer technique in laparoscopic radical proximal gastrectomy.Methods:The clinical data of 222 patients who underwent radical laparoscopic proximal gastrectomy for upper gastric cancer in the Shandong University of Qilu Hospital from January,2016 to December,2021 were retrospectively collected and analyzed.According to different ways of digestive tract reconstruction,they were divided into tubular esophagogastric anastomosis group(TG group)and traditional esophagogastric anastomosis group(EG group).The basic clinical data,intraoperative condition,postoperative pathology,postoperative recovery and postoperative long-term follow-up were compared.In addition,the tubular esophagogastric anastomosis group patients were divided into ICG group and non-ICG group according to whether or not indocyanine green(ICG)tracer technology was used during the operation,and the operation time,lymph node dissection,intraoperative blood loss of the two groups were compared.Results:There was no significant statistical difference in the basic clinical data between the two groups,and no significant statistical difference was observed in the operative time,intraoperative blood loss and postoperative pathology between the two groups.Patients in the tubular esophagogastric anastomosis group had less daily gastric tube drainage[37.5(19.0～65.0)VS 86.5(44.0～136.0)ml,P<0.001],and shorter gastric tube carrying time[(97.71±25.69)VS(116.86±27.02)h,P<0.001]and faster first drinking time[119.0(100.0～140.0)VS 130(110.5～150.0)h,P=0.005].The TG group had a lower proton pump inhibitor reuse rate(4.8%VS 19.8%,P<0.001)and a shorter application time[5.0(4.0～6.0)VS 6.0(5.0～7.0)days,P<0.001].In terms of long-term follow-up,patients in the TG group had better postoperative quality of life,as shown by lower incidence of reflux esophagitis,reflux esophagitis grade and GredQ score.However,according to the dysphagia score and the measurement of anastomotic width 3 months after surgery,the incidence of anastomotic stenosis was higher in the TG group.But after active clinical treatment,there was no significant difference in anastomotic status between the two groups in 12 months after surgery.Through univariate and multivariate analysis,the risk factor of postoperative anastomotic stenosis in patients was digestive tract reconstruction,that is,the possibility of anastomotic stenosis in patients undergoing tubular esophagogastric anastomosis was significantly increased.In the ICG subgroup analysis,patients in the ICG group had shorter operation time,less intraoperative blood loss,and more lymph node dissection than patients in the non-ICG group.All patients were followed up after surgery.The median follow-up time was 38(23～49)months,there was no significant difference in overall postoperative survival and progression-free survival between the two groups.Conclusion:(1)Tubular esophagogastric anastomosis after laparoscopic radical proximal gastrectomy for upper gastric cancer is safe and feasible.(2)Tubular esophagogastric anastomosis is simple in operation and has faster postoperative recovery,less gastroesophageal reflux and better postoperative quality of life compared with traditional esophagogastric anastomosis.(3)Despite the increased incidence of anastomotic stenosis after tubular esophagogastric anastomosis,the above symptoms improved significantly after active clinical intervention.(4)The application of ICG tracer technique in laparoscopic radical proximal gastrectomy has positive significance.(5)Tubular esophagogastric anastomosis is a recommended procedure for gastrointestinal reconstruction after radical proximal gastrectomy for upper gastric cancer.