Comparative Analysis Of Laparoscopic Proximal Gastrectomy Plus Semiembedded Valve Anastomosis With Laparoscopic Total Gastrectomy For Adenocarcinoma Of The Esophagogastric Junction

Objective: Gastroesophageal reflux may occur after proximal gastrectomy for carcinoma of the esophagogastric junction(adenocarcinoma of esophagogastric junction,AEG).We compared the short-term efficacy a nd long-term prognosis between proximal gastrectomy combined with se mi embedded valve anastomosis and laparoscopic total gastrectomy.Methods: We retrospectively analyzed the general data and surgical outcomes of patients with AEG who underwent three united laparoscop ic proximal gastrectomy plus semiembedded valve anastomosis(TULPGSEV,N=20)and LTG(N=20)at our hospital from January 2015 to Jan uary 2019 and investigated the incidence of postoperative reflux esophag itis and postoperative nutritional status between the two groups.Survival analysis was also performed.Results: The operative time(178.25±15.41 vs 196.5±21.16 min,P=0.03)of the TULPG-SEV group were significantly less than that of the LTG group.There was no difference in intraoperative blood loss,le ngth of hospital stay,and postoperative complications.There was no dif ference in the scores on the postoperative reflux disease questionnaires(RDQs)conducted 1 month(P=0.501),3 months(P=0.238),and 6 mont hs(P=0.655)after surgery between the TULPG-SEV group and LTG gr oup.Gastroscopy revealed 2 cases of reflux esophagitis(grade B or hig her)in each group.The postoperative hemoglobin level was better in th e TULPG-SEV group than in the LTG group,and the difference was m ost noticeable at one month after surgery(P=0.024)and three months after surgery(P=0.029).The levels of albumin and total protein were not significantly different between the groups.There were more patients wi th weight loss over 5 kg after surgery in the LTG group than in the T ULPG-SEV group(P=0.043).There was no significant difference in the three-year overall survival rate between the two groups(P=0.356).Conclusions:1.Semi-embedded valve anastomosis has a certain anti-reflux effect.2.Proximal gastrectomy may be superior to total gastrectomy in maintaining short-term postoperative hemoglobin levels and reducing body weight loss.