Clinical consequences and long-term results of laparoscopic-assisted proximal gastrectomy with double-tract reconstruction for proximal advanced gastric cancer: Propensity score-matched analysis

This study aimed to investigate the clinical consequences and future oncological results in patients with proximal advanced gastric cancer (AGC) having Laparoscopic-assisted proximal gastrectomy with double-tract reconstruction (LPG-DTR). A total of 134 patients who had proximal or complete gastrectomy (PG) at Xiamen University Attached Zhongshan Hospital between November 2018 to November 2023 were included in this research. Laparoscopically assisted total gastrectomy (LATG) was performed on 105 patients, while LPG-DTR was given on 29 patients. A comprehensive evaluation was conducted on surgical results, nutritional status, quality of life, and oncological outcomes using a 1:1 propensity score-matched (PSM) methodology to minimize biases. After PSM, we had 48 patients in overall. Compared to the LPG-DTR sample, the LATG sample 's mean operating hours was prolonged (P = 0.023). The LPG-DTR group had earlier first postoperative gas passage(P = 0.029). Total protein (P = 0.023) and albumin (P = 0.035) reduction rates in the LPG-DTR group were substantially lower at postoperative 3 months. The estimated 3-year overall survival (OS) rates were 82.0%in the LPG-DTR group but 82.6% in the LATG group (P = 0.804). The LPG-DTR group's 3-year recurrence-free survival (RFS) was 78.8%, while the LATG group' s was 69.1% (P = 0. 785). The metastatic rates of No.5 or 6 lymph node (LN) station for pathological T2/3/4 were 0%,3.1%, and 10.9% in patients. When tumor size was less than 4cm, the metastatic rates for pathological T3/4 dropped to 0% and 3.1%. For patients with proximal AGC, LPG-DTR was feasible and could offer better clinical effect.