Application of double tract reconstruction in laparoscopic assisted proximal gastrectomy for early upper gastric cancer

Objective To explore value of double tract reconstruction(DTR)in laparoscopic assisted proximal gastrectomy in the treatment of early upper gastric cancer. Methods The clinical data of 78 patients with early upper gastric cancer who received laparoscopic assisted proximal gastrectomy was analyzed retrospectively. According to different ways of digestive tract reconstruction, the patients were divided into two groups. A total of 43 patients who received traditional esophagogastrostomy(EG)were included in EG group, and 35 patients who received DTR were selected as DTR group. All patients were performed operations by experienced doctors in the same group, and completed the outpatient rechecks. Meanwhile, all of them were followed up successfully for at least one year, and the complete follow-up data were retained. The basic indexes of perioperative period, the incidence of postoperative complications, the nutritional status of the body and the conditions of daily meals were compared between the two groups. Results Compared with the EG group, the postopertive ventilation time in the DTR group was significantly shorter, and operation time was significantly longer(P<0.05). The result of one year follow-up showed that the incidence of reflux esophagitis in the DTR group was 8.57%, which was lower than 30.23% in the EG group(P<0.05). The proportion of patients with Ⅰ or Ⅱ Visick grading at 6 months after operation was 85.71%, which was significantly higher than 65.12% in the EG group(P<0.05); DTR group had significantly higher hemoglobin(Hb)- levels at 6 months and 1 year after operation compared with the time point of discharge(P<0.05), and they were significantly higher than that of EG group at the same time points(P<0.05). The patients in the DTR group all recovered to be normal diet after one year of operation, the proportions of patients having three meals and ≥ 4 meals per day accounted for 88.57% and 11.43%, respectively. The recovery condition of food-intake in the DTR group was significantly better than that of EG group(P<0.05). Conclusion DTR for digestive tract reconstruction can shorten postoperative ventilation time, reduce the occurrence of reflux esophagitis, improve the nutritional status and promote the recovery of normal eating habits in patients with upper gastric cancer during laparoscopic assisted proximal gastrectomy.