Comparison of channel esophagogastrostomy and double tract reconstruction after laparoscopic-assisted proximal gastrectomy: a propensity score-matched analysis.

BACKGROUND

Digestive tract reconstruction following proximal gastrectomy necessitates a synchronized approach to optimizing both anti-reflux efficacy and nutritional metabolism maintenance. However, academic debate over the optimal reconstruction technique remains ongoing. This study aims to compare the clinical outcomes of Channel Esophagogastrostomy (CE) and Double Tract Reconstruction (DTR) following laparoscopic-assisted Proximal Gastrectomy (LAPG).

METHODS

A consecutive cohort of patients who underwent LAPG between September 2020 and September 2023 was included. Multivariable propensity score matching was applied to match cases in the CE group and the DTR group at a 1:2 ratio. The primary outcomes included perioperative safety and procedural feasibility; secondary outcomes included reflux control and nutritional recovery. The study was retrospectively registered on ClinicalTrials (NCT06741124).

RESULTS

After PSM, a total of 99 patients were included (CE group: 33, DTR group: 66), with balanced baseline characteristics between the two groups. The anastomosis time was significantly longer in the CE group compared to the DTR group (46.8 ± 9.6 vs. 29.1 ± 4.6 min, p < 0.001). One-year postoperative endoscopic evaluation showed a lower incidence of reflux esophagitis in the CE group compared to the DTR group (44% vs. 67%; p = 0.121), although this difference did not reach statistical significance. However, the PGSAS-45 questionnaire at one year postoperatively demonstrated a lower esophageal reflux subscale score in the CE group, suggesting a potential benefit in reflux symptom control. Regarding nutritional recovery, the CE group exhibited significantly higher hemoglobin levels at three months postoperatively (124.3 ± 20.8 vs. 115.7 ± 16.9 g/dL, p = 0.04) and a lower rate of body weight loss at 6 months postoperatively.

CONCLUSION

CE reconstruction following LAPG was associated with acceptable perioperative safety and surgical feasibility, as well as fewer reflux symptoms, lower PPI usage, reduced endoscopic evidence of reflux esophagitis, and improved nutritional preservation compared to DTR, supporting its potential as a viable surgical alternative.