Application Of Laparoscopic-assisted Proximal Gastrectomy With Double-tract Anastomosis In Proximal Early Gastric Cancer

Objective The efficacy of proximal gastrectomy in the treatment of early proximal gastric cancer has been widely accepted,The reconstruction of digestive tract by double channel anastomosis is helpful to reduce postoperative complications such as reflux esophagitis and postoperative malnutrition.This study aims to compare the clinical curative effect of patients who underwent proximal gastrectomy with double-tract anastomosis(PGDT)with those underwent total gastrectomy with Roux-en-Y anastomosis(TGRY).Methods From 2013 to 2015,thirty-eight patients underwent PGDT,and forty-five patients underwent TGRY.The general characteristics,surgical efficacy and short-term follow-up outcomes were compared between the two groups.The demographic characteristics,the pathological characteristics of tumors,surgical efficacy indicators(including surgical safety,early postoperative complications,postoperative hospitalization days)and short-term follow-up results(short-term postoperative complications,Nutritional parameters such as hematology and body weight,postoperative feeding function,and the survival rate).Results There were no significant differences in the general information,clinicopathological characteristics of tumors(P>0.05),There were no significant differences in operative safety information such as intraoperative blood loss and duration of operation(P > 0.05).There was no statistically significant difference in early postoperative complications such as incision infection,intestinal obstruction,anastomotic bleeding,anastomotic fistula,anastomotic stenosis,abdominal infection,and pulmonary infection(P > 0.05).The mean postoperative hospital stay in the PGDT group were statistically shorter than those in the TGRY group(PGDT vs TGRY,10.4d vs 13.0d,P=0.001).There was no statistically significant difference between the two groups in postoperative gastroscopy for six months,including anastomotic inflammation,anastomotic ulcer and reflux esophagitis(P > 0.05).One patient in the PGDT group presented dumping syndrome postoperatively.In the TGRY group,eight patients developed dumping syndrome,the difference between the two groups was statistically significant(P=0.032).Most of the PGDT patients and half of the TGRY patients can eat three times per day in the twelfth month after surgery.The difference was statistically significant(P=0.017).The PGDT group showed significantly better hemoglobin levels in the second year(PGDT vs TGRY,132.7±12.2 g/L vs 126.7±9.0 g/L,P=0.039).The three year survival rate was not significantly different between the two groups by the log-rank test(p = 0.757).Conclusion PGDT is a safe,effective radical surgical method for proximal early gastric cancer.Compared with TGRY in the short term,it leads to better outcomes in terms of the single-meal food intake and hemoglobin level,without increasing the incidence of postoperative reflux esophagitis.