| Background: Proximal gastrectomy with gastric tube reconstruction is a surgical procedure that can preserve function in patients with proximal gastric cancer.However,whether gastric tube reconstruction with proximal gastrectomy has certain advantage in some aspects over total gastrectomy is controversial.To evaluate the benefit of gastric tube reconstruction after proximal gastrectomy,we compared gastric tube reconstruction with total gastrectomy for proximal gastric cancer.Methods: A retrospective collection of 351 upper one-third of gastric cancer patients in the Department of Gastrointestinal Surgery of the Affiliated Hospital of Qingdao University from January 2017 to February 2021 was enrolled.Concurrent total gastrectomy patients matched with the Proximal gastrectomy group in age,sex,body mass index,clinical stage,and ASA score were selected by propensity score matching.Preoperative basic information,perioperative indicators,histopathological features,postoperative complications and nutritional status,reflux were compared between the two groups.Results: There was no significant difference in the incidence of reflux between two groups(14.8% and 6.5% respectively,P=0.085).The blood loss and operation time in the PG group were lower than those in TG group,but there were no significant differences(P > 0.05).After propensity score matching,the start of a soft diet after the operation in the PG group was 0.7 days sooner than in the TG group(4.06 ± 1.81 vs.4.76 ± 1.69;P = 0.047),and the recovery time of bowel function in the PG group was 0.72 days shorter than in the TG group(2.29 ± 1.16 vs.3.01 ± 1.22;P = 0.039).In the matched cohort,there were no statistically significant differences in the length of postoperative hospital stay,the average maximum body temperature in the first three days after surgery,and the number of patients using analgesics 1–5 days after surgery(P > 0.05).There was no significant difference in clinical characteristics between the two groups 1 year after the operation.Overall,26 patients in the PG group and 43 patients in the TG group(P = 0.312)reported no dietary problems.Reflux was present in 6 patients in the PG group and 3 patients in the TG group(P = 0.069),and there was no significant difference.In terms of nutrition score,although there was no statistical significance in different degrees of malnutrition between the two groups(P = 0.406),the PG group included a large proportion of mild malnutrition patients: 21(38.9%)in the PG group and 33(30.6%)in the TG group.The annual decrease in serum hemoglobin in the TG group was greater than that in the PG group,and the decrease in serum hemoglobin in the TG group at 3 and 6 months after surgery was significantly higher than that in the PG group(P = 0.032 and 0.046,respectively),There was no significant difference between the two groups at 1 and 12 months after surgery(P = 0.131 and P = 0.072,respectively).Regarding PNI,there was no significant difference between the PG group and the TG group(P > 0.05).However,the PNI decline in the TG group was always higher than that in the PG group after surgery.Although the TG group recovered faster from 1 to 3 months,the curves between the two groups have no intersection.Serum prealbumin levels in both groups were not significantly different at any time point(P > 0.05),but the TG group recovered faster at 3 to 6 months after surgery,and the levels in the two groups were almost the same at 12 months.Like albumin,there was no statistical significance at any time point,and the trend of change was not exactly the same as that of prealbumin.One month after surgery,%BW loss in TG group was significantly lower than that in the PG group(P = 0.024),and 6 months after surgery,%BW loss in the TG group was higher than that in the PG group.No significant differences were observed at any time point in % PMI loss between the two groups.Conclusions: The Proximal gastrectomy group has better short-term clinical outcome and gastric tube reconstruction is simple,similar complications and reflux rates,and the PG group has better nutritional performance,gastric tube reconstruction may be more suitable for proximal gastric cancer. |
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