Modified Double-Tract Reconstruction in Terms of postoperative quality of life of Patients with Early Adenocarcinoma of Esophagogastirc Junction after Proximal Gastrectomy

Abstract

Abstract Background Increased reflux symptoms limited clinical application of proximal gastrectomy (PG) in the patients with early adenocarcinoma of esophagogastirc junction (AEG). The purpose of this study is to describe a method of modified double-tract reconstruction (DTR) after PG, and to evaluate the feasibility, safety, surgical outcomes, postoperative gut function and nutritional status post operation. Methods Prospective cohort data of 25 patients with early AEG who presented to a single tertiary hospital from Jan 2019 to Jun2019 and underwent DTR after PG were analyzed respectively. The data of this prospective cohort included: clinicopathologic characteristics, surgical outcomes, time to first flatus and defecation, Visick Score, degrees and extent of remnant gastritis, Los Angles Classification in 1-year follow-up. Another 25 early AEG patients performed TG by propensity score matching analysis from Jan 2018 to Dec 2018 were picked as control group. Results There was no significant difference in BMI, ASA score, tumor size, Siewert type, tumor Grade, proximal resection margin, the number of LN harvested and TNM Stage between two groups.The operation time and hospital stay was longer, and estimated blood loss was more in DTR group. The postoperative complication rate was 8% (n = 2), which were both treated by conservative management. The volume of postoperative daily intake could reach over 700ml on 6th POD, which was much more than TG group. The weight loss of patients in DTR group remained steadily from 3rd month after operation, which was also better than TG group. The rate of reflux symptoms was 12% (n = 3), which were classified as Visick grade II. The degree and extent of remnant gastritis in DTR group were acceptable. The incidence of residual food in remnant stomach reached 32%, but most of them were only evaluated as Grade 1.ConclusionThe short-term outcome of this modified DTR was satisfied, which could improve the nutrition status and quality of life post operation. We believe our modified technique is one of feasible, safe, and useful choice for early AEG patients.