Xu Zhiwen, Chen Jinping, Chen Shaoqin, Lin Hexin, Zhao Kang, Zheng Changyue, Liu Huibin, Chen Zhihua, Fu Yongan, Hong Qingqi, Lin Wei, Yan Su, You Jun
Department of Gastrointestinal Oncology Surgery, the First Affiliated Hospital of Xiamen University, Xiamen, China.
School of Medicine, Xiamen University, Xiamen, China.
Front Oncol. 2023 Jun 2;13:1137836. doi: 10.3389/fonc.2023.1137836. eCollection 2023.
Laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic proximal gastrectomy with tube-like stomach reconstruction (LPG-TLR) are both function-preserving procedures performed for treating AEG. However, there is no clinical consensus on the selection of digestive tract reconstruction after proximal gastrectomy, and the best way to reconstruct the digestive tract remains controversial. This study aimed at comparing the clinical outcomes of LPG-DTR and LPG-TLR to provide some reference to the choice of AEG surgical modalities.
This was a multicenter, retrospective cohort study. we collected clinicopathological and follow-up data of patients with consecutive cases diagnosed with AEG from January 2016 to June 2021 in five medical centers. According to the way of digestive tract reconstruction after tumor resection, patients who underwent LPG-DTR or LPG-TLR were included in the present study. Propensity score matching (PSM) was performed to balance baseline variables that might affect the study outcomes. The QOL of the patients was evaluated using the Visick grade.
A total of 124 eligible consecutive cases were finally included. Patients in both groups were matched using the PSM method, and 55 patients from each group were included in the analysis after PSM. There was no statistically significant difference between the two groups in terms of the operation time, amount of intraoperative blood loss, days of postoperative abdominal drainage tube placement, postoperative hospitalization days, total hospitalization cost, the total number of lymph nodes cleared, and the number of positive lymph nodes (>0.05). There was a statistically significant difference between the two groups in terms of time to first flatus after surgery and postoperative soft food recovery time (<0.05). For the nutritional status, the weight levels at 1 year after surgery was better in the LPG-DTR group than in the LPG-TLR group (<0.05). There was no significant difference in Visick grade between the two groups (>0.05).
The anti-reflux effect and quality of life of LPG-DTR for AEG were comparable to those of LPG-TLR. Compared with LPG-TLR, LPG-DTR provide better nutrition status for patients with AEG. LPG-DTR is a superior reconstruction method after proximal gastrectomy.
腹腔镜近端胃切除术联合双通道重建（LPG-DTR）和腹腔镜近端胃切除术联合管状胃重建（LPG-TLR）都是用于治疗食管胃交界部腺癌（AEG）的保留功能的手术方式。然而，近端胃切除术后消化道重建方式的选择尚无临床共识，消化道重建的最佳方式仍存在争议。本研究旨在比较LPG-DTR和LPG-TLR的临床疗效，为AEG手术方式的选择提供参考。
这是一项多中心回顾性队列研究。我们收集了2016年1月至2021年6月期间在五个医疗中心连续诊断为AEG的患者的临床病理和随访数据。根据肿瘤切除后消化道重建的方式，将接受LPG-DTR或LPG-TLR的患者纳入本研究。进行倾向评分匹配（PSM）以平衡可能影响研究结果的基线变量。使用Visick分级评估患者的生活质量（QOL）。
最终共纳入124例符合条件的连续病例。两组患者采用PSM方法进行匹配，PSM后每组各有55例患者纳入分析。两组在手术时间、术中出血量、术后腹腔引流管放置天数、术后住院天数、总住院费用、清扫淋巴结总数及阳性淋巴结数方面差异均无统计学意义（>0.05）。两组在术后首次排气时间和术后软食恢复时间方面差异有统计学意义（<0.05）。在营养状况方面，LPG-DTR组术后1年的体重水平优于LPG-TLR组（<0.05）。两组Visick分级差异无统计学意义（>0.05）。
LPG-DTR治疗AEG的抗反流效果和生活质量与LPG-TLR相当。与LPG-TLR相比,LPG-DTR为AEG患者提供了更好的营养状况。LPG-DTR是近端胃切除术后一种更优的重建方法。
