Comparative Study On The Clinical Efficacy Of Different Digestive Tract Reconstruction Methods After Proximal Gastrectomy For Adenocarcinoma Of The Esophagogastric Junction

ObjectiveProximal gastrectomy(PG)has been used for adenocarcinoma of the esophagogastric junction(AEG)for many years.However,there is no uniform standard for the digestive tract reconstruction after PG By investigating the short-term clinical effects of four different digestive tract reconstruction methods(esophagogastric anterior wall anastomosis,double tract jejunal interposition reconstruction,single tract jejunal interposition reconstruction,overlap tube gastroesophageal anastomosis)after PG for Siewert Ⅱ,Ⅲ AEG,to further clarify the pros and cons of various digestive tract reconstruction methods,in order to provide a reliable basis for clinicians’ diagnosis and treatment,so as to effectively improve the Postoperative living quality of patients.MethodsThe clinical data of 119 patients with Siewert Ⅱ and Ⅲ AEG who underwent PG from January 2018 to April 2020 in the Hospital were retrospectively analyzed.According to differences of digestive tract reconstruction,they are divided into four groups:traditional esophagogastric anterior wall anastomosis group(EG),double tract jejunal interposition reconstruction(DTR),single tract jejunal interposition reconstruction(STR),overlap tube gastroesophageal anastomosis(OTG),the last three groups are anti-reflux gastrointestinal reconstruction group.Analyzed patients’ general information,perioperative indicators,RDQ scores,postoperative complications,especially postoperative reflux esophagitis(RE),anastomotic stenosis,and postoperative nutritional status.SPSS26.0 statistical software was used for analysis.The results of the analysis were statistically significant with the difference of p<0.05.Results1.Comparison of general data for the four groups of patients:Comparison of age,sex,BMI,postoperative TNM stage,tumor differentiation,tumor size,Siewert type and otherindicators,the difference was not statistically significant(P>0.05).2.Comparison of perioperative indicators:The operation time of the three anti-reflux digestive tract reconstruction groups was significantly longer than the EG group(P<0.05),but the differences of any two among the three anti-reflux digestive tract reconstruction groups were not statistically significant(P>0.05).The volume of intraoperative blood loss and postoperative short-term recovery indicators(ventilation time,postoperative defecation time,postoperative eating time,postoperative hospital stay)were similar in the four groups(P>0.05).The short-term postoperative recovery time of the OTG group was the shortest among the four groups.3.Postoperative gastroesophageal reflux-related complications:The RDQ scores at 1,3,and 6 months after surgery and the incidence of GERD at 6 months after surgery of the three anti-reflux digestive tract reconstruction groups were all significantly lower than the EG group(P<0.05),and the differences of any two among the three anti-reflux digestive tract reconstruction groups were not statistically significant(P>0.05).The incidence of RE in the four groups at 6 months after operation were:EG group(25%),DTR group(2.94%),STR group(4%),OTG group(3.57%).We found that the incidence of RE in the DTR group was significantly lower than that in the EG group at 6 months after surgery by comparing every two among the four groups(P=0.024),and the differences of other any two among the four groups were not statistically significant(P>0.05).4.Comparison of other postoperative complications:The incidence of anastomotic stenosis and gastric retention in the group of DTR,STR,OTG was all lower than the EG group.we found that the incidence of gastric retention and anastomotic stenosis in the DTR group was the lowest in the four groups by comparing every two among the four groups,and was significantly lower than that in the EG group(P<0.05).In addition,the total postoperative complication incidence of the three anti-reflux digestive tract groups was all significantly lower than the EG group(P<0.05),and the differences of any two among the three anti-reflux digestive tract reconstruction groups were not statistically significant(P>0.05).5.Comparison of postoperative nutritional status:postoperative nutritional indicators included TP,ALB,HB,body weight of the three anti-reflux digestive tractreconstructiongroups were significantly higher than those of the EG group(P<0.05),and the differences of any two among the three anti-reflux digestive tract reconstruction groups were not statistically significant.(P>0.05).Further comparison of the nutritional indicators in the four groups at 6 months after surgery with preoperatively showed that the nutritional indicators in the EG group,DTR group,and OTG group at 6 months after surgery were significantly lower than those before surgery,and the differences were all statistically significant(P<0.05).There were no significant differences in total protein,ALB,and body weight in the STR group between 6 months after surgery and preoperational(P>0.05).Conclusions1.The safety and short-term postoperative recovery status of the four digestive tract reconstruction methods(EG,DTR,STR,OTG)after PG were similar.Patients in the four groups successfully completed the surgery and recovered well after the operation.OTG surgery has low invasiveness and the earliest recovery of gastrointestinal function after surgery.2.Compared with EG,the three anti-reflux digestive tract reconstruction procedures(DTR,STR and OTG)effectively reduced the incidence of RE and other postoperative gastroesophageal reflux and improved the living quality of patients after surgery.3.The incidence of other complications except RE after the three kinds of anti-reflux digestive tract reconstruction surgery is also lower than that of EG,and the incidence of total complications after the three anti-reflux digestive tract reconstruction surgery is significant Lower than EG,Therefore,it can be considered that the three types of anti-reflux gastrointestinal reconstruction surgery also play a certain role in preventing postoperative complications other than reflux esophagitis,and further improve the patients’ living standards after surgery.Among them,DTR has obvious advantages in preventing gastric retention and anastomotic stenosis.4.Compared with EG,the three anti-reflux digestive tract reconstruction procedures have obvious advantages in improving the nutritional status of patients after surgery,and they are beneficial to improve the long-term living quality of patients after surgery.In addition,the postoperative nutritional status of STR recovered best.