Totally laparoscopic total gastrectomy with Uncut Roux-en-Y for gastric cancer may improve prognosis: A propensity score matching comparative study

Abstract

BackgroundLaparoscopic total gastrectomy (LTG) with Roux-en-Y (RY) is often accompanied by a series of complications. Uncut RY (URY) can effectively reduce Roux stasis syndrome (RSS) in laparoscopic distal gastrectomy. To determine whether totally LTG (TLTG) with URY for gastric cancer (GC) can replace RY in short-term and long-term prognosis.MethodsThis comparative retrospective study selected GC patients from 2016 to 2022. The patients were divided into URY group and RY group. Cox multivariate proportional hazard regression analysis was used to explore the independent prognostic factors. Propensity score matching (PSM) was used to reduce bias.ResultsA total of 100 GC patients met the inclusion criteria. Compared to RY group, URY group showed significant advantages in operation time and length of hospital stay. In addition, URY group can significantly reduce short-term and long-term complications, especially RSS. The 1-, 3- and 5-year progression free survival (PFS) of URY group and RY group were 90.4% vs. 67.8% (P=0.005), 76.6% vs. 52.6% (P=0.009) and 76.6% vs. 32.8% (P<0.001), respectively. After PSM, the advantage of URY in PFS was verified again, while there was no significant difference in overall survival (OS) between the two groups. Cox multivariate analysis suggested that lower RSS was associated with better PFS.ConclusionsTLTG with URY for GC helps control disease progression, speed up recovery and reduce short and long-term complications, especially RSS.

Efficacy and safety of totally laparoscopic gastrectomy with Uncut Roux-en-Y for gastric cancer: A dual-center retrospective study

“…Then, the relevant factors (P < 0.1) were included in the multivariate analysis. All results with P < 0.05 were considered signi cant [21].…”

“…To improve the reliability of the study, Propensity score matching (PSM) was used to eliminate the effect of baseline imbalance [21]. Multiple logistic regression was used to measure propensity scores for each patient [21,26]. Operative method, TNM stage, and differentiation degree were included as matching variables.…”

“…URY was gradually applied to GC because of its simplicity [30]. URY can effectively reduce RSS caused by digestive tract reconstruction and increase QoL [21,29,31]. However, whether URY has input loop recanalization [32], and whether it can improve the long-term prognosis of GC patients are currently a research focus [21].…”

“…Then, we performed the jejunal Braun anastomosis. Close the input loop jejunum, which was 2 cm ~ 3 cm from the gastrointestinal anastomosis, using uncut linear cutting closure [21].…”

“…Progressionfree survival (PFS): from TLG to the last follow-up or recurrence [21]. OS: from TLG to the last follow-up or death [21]. The short-term complications were de ned as those that occur within 30 days of operation (Clavien-Dindo) [22].…”