A modified double-tract reconstruction following laparoscopic proximal gastrectomy for Siewert Ⅱ adenocarcinoma of the esophagogastric junction (with video)

Objective The incidence of adenocarcinoma of the esophagogastric junction (AEG) is increasing. For patients with resectable Siewert Ⅱ AEG, there is still a lack of consensus with regards to which surgical procedure can well balance survival time and quality of life. This study aims to describe a modified double-tract reconstruction (DTR) method following laparoscopic proximal gastrectomy (LPG) and to evaluate the feasibility, safety, and effects of this novel method. Method This study retrospectively reviewed 29 patients who received modified DTR after LPG for Siewert Ⅱ AEG at a single center between August 2015 and October 2020. Clinicopathological characteristics, surgical outcomes, nutritional status and dietary ability were analyzed. Result The mean surgical time was 206.4 ± 39.2 min, mean intraoperative blood loss was 175.9 ± 41.4 mL, and median postoperative hospital stay was 11 d (range, 9–70 d). The early complication rate was 13.8% (n = 4), and the late complication rate was 6.9% (n = 2). No reflux esophagitis or reflux symptom was recorded. There were no perioperative deaths within three months post-operatively. At the third follow-up month after surgery, most patients (25/29, 86.2%) were experiencing sufficient oral food intake, with a median frequency of 5 meal/d (range, 3–6 meal/d). The median total weight loss was 8 kg (range, 0–15 kg) and there were no case of post-operative malnutrition. Conclusion The modified DTR method following LPG represents a novel, safe, and feasible method that provides sufficient nutritional support with few diet-related discomforts. Prospective large-scale randomized trials are now needed to validate the clinical applicability of this method.