Minimally invasive proximal gastrectomy and double tract reconstruction

Abstract

Advances in gastric cancer surgery comprise the use of minimally invasive surgery such as laparoscopic or robotic techniques. Besides the technical progress, little changes have been established in the last decades regarding the lymphadenectomy, luminal resection type and reconstruction. Lately, proximal gastrectomy and reconstruction with double tract method became more popular and might lead to new possibilities of tailored luminal resections in gastric cancer and cancer of the esophagogastric junction. This procedure is established in east Asia, but of high interest for western countries, as the incidence of proximal gastric cancer and junctional cancer is rising. So far, limited evidence is disposable regarding the double tract method and the indication is seen for rather early cancer. Focus should be put on rapid evaluation on oncological safety and functional benefits in order to evaluate this surgical alternative to total gastrectomy, which is also feasible in laparoscopic or robotic-assisted procedures. This review aims to provide a current status of the proximal gastrectomy and double tract reconstruction, information on how it is done, and which patients could qualify for this surgery. Western surgeons should scientifically cooperate when performing this procedure in order to effectively evaluate whether the distal stomach preservation comes along with benefits