Functional benefits of the double flap technique after proximal gastrectomy for gastric cancer

Abstract

Background Proximal gastrectomy is a widely performed procedure that has become more common with an increasing number of proximal gastric cancer cases. Several types of reconstructive procedures after proximal gastrectomy have been developed, and it remains controversial which procedure is the most advantageous with regard to the preservation of postoperative gastric stump function and nutritional status. In the present study, we retrospectively analyzed reconstructive procedures in a consecutive case series for proximal gastrectomy, primarily focusing on postoperative body weight maintenance, nutritional status, and gastric remnant functional preservation. Methods We enrolled 69 patients who had undergone proximal gastrectomy for gastric cancer in our institute between 2005 and 2020. Short-term complications, preservation of gastric remnant functions, nutritional status, and post-operative weight changes were compared. Results After proximal gastrectomy, the numbers of patients who underwent direct esophago-gastrostomy, jejunal interposition, double tract reconstruction, and the double flap technique were 9, 10, 14, and 36, respectively. The patients in whom the double flap technique was performed suffered no reflux esophagitis after surgery. Prevalence of gastric residual at 12 months after surgery was lowest in the double flap technique group. Moreover, the double flap technique group had a better tendency regarding post-operative changes of serum albumin ratios. Furthermore, the post-operative body weight change ratio of the double flap technique group was smallest among all groups and was significantly better than that of the double tract group. Conclusions The double flap technique after proximal gastrectomy was considered the most effective technique for reconstruction which leads to better bodyweight maintenance, and results in less reflux esophagitis.

Study protocol for comparing the efficacy of left-open single-flap technique versus double-flap technique after proximal gastrectomy: A multicenter randomized controlled trial

“…This structure is similar to the "reconstructed cardia" structure, which can improve the antireflux effect. Saze Z et al (16) found that the double-flap technique did not result in postoperative reflux esophagitis and had the smallest postoperative weight change ratio and the lowest prevalence of gastric residual at 12 months after surgery compared with direct esophagogastrostomy, jejunostomy and double tract reconstruction.…”

“…By comparing patients who underwent direct esophagogastrostomy, jejunal interposition, double tract reconstruction, and the double-flap technique, Shoji Y ( 15 ) and Saze Z et al. ( 16 ) found that patients undergoing double-flap anastomosis had no reflux esophagitis and a lower incidence of postoperative anastomotic stricture, which improved postoperative serum albumin ratio changes and weight maintenance. Consequently, the double-flap technique is considered to be the most effective technique for proximal gastric reconstruction ( 17 , 18 ).…”

“…However, the double-flap technique is associated with shortcomings, such as a more complex suture technique, more difficult operation, longer operation time and higher incidence of postoperative anastomotic stenosis ( 15 , 16 , 19 ). Therefore, our center attempted the left-open single-flap technique to reduce the difficulty of surgical suturing and the incidence of complications.…”

Protocol for Comparing the Efficacy of Three Reconstruction Methods of the Digestive Tract (Kamikawa Versus Double-Tract Reconstruction Versus Tube-Like Stomach) After Proximal Gastrectomy

“…Advantages: This is the first prospective large sample multicenter RCT to systematically compare the efficacy of three reconstruction methods of the digestive tract (Kamikawa versus DTR versus tube-like stomach) after proximal gastrectomy. Previous studies were mostly retrospective studies ( 25 – 27 ). A few prospective studies focused only on comparing the two reconstruction methods ( 28 , 29 ).…”

The role of proximal gastrectomy in gastric cancer

“…In conclusion, both DTR and DFT appear to be safe, feasible, and effective anti-reflux reconstruction methods after PG; however, it remains unclear which method is safer and provides better nutritional and symptomatic outcomes. Although several studies have compared DFT and DTR and reported that DFT is nutritionally superior (50)(51)(52), all of these were single-center retrospective studies. In addition, because of the most of these reports are from Eastern countries, whether these techniques are safe and effective for Western patients is unknown.…”