Qiu Ti-Hong, Wen Hong-You, Chen Ming-Ming
Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Chengdu Medical College, Pidu District People's Hospital, Chengdu 611730, Sichuan Province, China.
World J Gastrointest Surg. 2025 Jun 27;17(6):104192. doi: 10.4240/wjgs.v17.i6.104192.
Although surgery remains the primary treatment for proximal gastric cancer (PGC), ongoing refinements in surgical strategies are essential to improving clinical outcomes.
To investigate the effect of double-tract reconstruction (DTR) on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy (LPG).
In total, 78 patients with PGC admitted between August 2020 and August 2024 were enrolled. The research group consisted of 39 patients who underwent DTR + LPG, whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy. Perioperative indices (intraoperative blood loss, digestive tract anastomosis time, and time to first postoperative flatus), postoperative complications (intestinal obstruction, anastomotic ulcer, diarrhea, dumping syndrome, and gastroesophageal reflux), nutritional parameters (serum albumin, hemoglobin, and body mass index), immune function [immunoglobulin (Ig) G, IgA, and IgM), and stress response indicators (C-reactive protein, interleukin-6, and tumor necrosis factor-α) were collected and analyzed for both groups.
The intraoperative blood loss was lower ( < 0.05), and the time to first postoperative flatus time was shorter ( < 0.001) in the research group than in the control group. The two groups had comparable digestive tract anastomosis time ( > 0.05). The overall complication rate was significantly lower in the research group than in the control group ( = 0.042). Compared with the control group, the research group exhibited notably higher albumin, hemoglobin, and body mass index levels at 2 and 3 months postoperatively, as well as considerably high immunoglobulin (Ig) G, IgA, and IgM levels on postoperative day 1 ( < 0.05). The postoperative levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were also lower in the research group than in the control group ( < 0.001).
The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses, showing more advantages over laparoscopic total gastrectomy.
尽管手术仍是近端胃癌（PGC）的主要治疗方法，但不断完善手术策略对于改善临床结局至关重要。
探讨双通路重建（DTR）对接受腹腔镜近端胃切除术（LPG）患者免疫功能和应激反应的影响。
共纳入2020年8月至2024年8月收治的78例PGC患者。研究组由39例行DTR+LPG的患者组成，而对照组由39例行腹腔镜全胃切除术并 Roux-en-Y 食管空肠吻合术的患者组成。收集并分析两组患者的围手术期指标（术中出血量、消化道吻合时间和首次术后排气时间）、术后并发症（肠梗阻、吻合口溃疡、腹泻、倾倒综合征和胃食管反流）、营养参数（血清白蛋白、血红蛋白和体重指数）、免疫功能[免疫球蛋白（Ig）G、IgA和IgM]以及应激反应指标（C反应蛋白、白细胞介素-6和肿瘤坏死因子-α）。
研究组术中出血量低于对照组（<0.05），首次术后排气时间短于对照组（<0.001）。两组消化道吻合时间相当（>0.05）。研究组总体并发症发生率显著低于对照组（=0.042）。与对照组相比，研究组术后2个月和3个月时白蛋白、血红蛋白和体重指数水平显著更高，术后第1天免疫球蛋白（Ig）G、IgA和IgM水平也显著更高（<0.05）。研究组术后C反应蛋白、白细胞介素-6和肿瘤坏死因子-α水平也低于对照组（<0.001）。
DTR与LPG联合治疗PGC患者在增强免疫功能和抑制应激反应方面更有效，比腹腔镜全胃切除术具有更多优势。
