Comparison of short-term efficacy of laparoscopic proximal gastrectomy with modified side overlap anastomosis and laparoscopic total gastrectomy with Roux-en-Y anastomosis.

Background: To investigate the short-term efficacy of laparoscopic proximal gastrectomy (LPG) with modified side overlap anastomosis in comparison with laparoscopic total gastrectomy (LTG) with Roux-en-Y anastomosis.

Methods: A retrospective cohort study was conducted. The clinicopathological data of 262 patients who underwent LPG or LTG for upper gastric adenocarcinoma from January 2016 to December 2022 were collected. Among 262 patients, 20 who underwent LPG with a modified side overlap anastomosis were assigned to the side overlap group, and 242 who underwent LTG with Roux-en-Y anastomosis were assigned to the Roux-en-Y group. After 1:1 matching of patients in the side overlap and Roux-en-Y groups via the propensity score matching method, 15 patients were included in this study. The outcome measures included the following: (1) intraoperative conditions, (2) postoperative recovery and (3) follow-up information.

Results: (1) Intraoperative conditions. Compared with the Roux-en-Y group, the side overlap group had a longer digestive tract reconstruction time. No significant difference was observed in the total operation time or amount of intraoperative blood loss. (2) Postoperative recovery. No statistically significant difference was detected between the side overlap and Roux-en-Y groups in terms of indicators, such as first anal exhaust time, first postoperative liquid intake time, postoperative hospitalization time and postoperative complications. (3) Follow-up information. The body mass index, haemoglobin, albumin, and Nutritional Risk Screening 2002 scores of the side overlap group were better than those of the Roux-en-Y group at 12 and 18 months after surgery. No significant difference was observed in the gastroesophageal reflux disease scale score or occurrence of ≥ Grade B reflux oesophagitis at 12 and 18 months after surgery between the side overlap and Roux-en-Y groups.

Conclusions: LPG with a modified side overlap anastomosis is safe and feasible for the treatment of upper gastric adenocarcinoma and can achieve good antireflux effects. In addition, compared with traditional LTG, the postoperative nutritional status after LTG is better.