Feasibility of Laparoscopic Proximal Gastrectomy With Piggyback Jejunal Interposition Double-Tract Reconstruction for Proximal Gastric Cancer. A Propensity Score Matching Analysis

Background The clinical effect of laparoscopic proximal gastrectomy (LPG) with piggyback jejunal interposition double-tract reconstruction (PJIDTR) is not clear yet. The purpose of this study was to compare the efficacy of LPG with PJIDTR versus laparoscopic total gastrectomy (LTG) with Roux-en-Y reconstruction (overlap method) for proximal EGC using propensity score matching. Methods We retrospectively collected data from the patients with proximal EGC who were treated in Shanxi Cancer Hospital between January 2012 and December 2015. Propensity score was used to match LTG patients with LPG patients. The patient characteristics, clinical outcomes, nutritional indicators, reflux esophagitis incidence and overall survival were compared between the two groups. Results Of the 424 patients, 200 were excluded and 50 of the remaining patients received LPG with PJIDTR. Fifty matched LTG patients were screened. Comparison of intraoperative indicators, operative time, blood loss and number of retrieved lymphnodes between the two groups showed no statistical significance (P > 0.05). There was no statistically significant differences in first anal exhaust time, postoperative hospital stay, and early complications between the two groups (P > 0.05). The nutrition indexes at one year after surgery in the LPG group were significantly better than LTG group (P p = 0.08). Conclusion The postoperative nutritional outcomes of LPG with PJIDTR were better than those of LTG. The incidence of reflux esophagitis, complications, and 5-year overall survival were similar between the two groups. LPG with PJIDTR may be suitable for proximal EGC.