Scholarlink

Background <p>Optimal reconstruction after laparoscopic proximal gastrectomy (LPG) remains debated. This study compared perioperative outcomes and long-term quality of life (QoL) between tubular esophagogastric (TEG) and double-tract (DT) anastomosis, with attention to age-dependent effects.</p> Methods <p>This retrospective cohort study included 284 patients undergoing LPG with TEG or DT. Exploratory age-stratified analyses were performed. QoL was evaluated using GerdQ, dysphagia scores, and the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).</p> Results <p>DT was associated with longer operative time than TEG (232.1 vs 217.6&#xa0;min, P = 0.016), primarily due to prolonged reconstruction time (90.3 vs 66.0&#xa0;min, P &lt; 0.001). In an exploratory analysis of patients aged ≥ 70&#xa0;years, TEG was associated with fewer overall complications than DT (25.9% vs 50.0%, P = 0.049), while complication severity by Clavien–Dindo grade was comparable between groups. This divergence was primarily attributable to non-anastomosis-related complications rather than anastomotic events. In multivariable analysis within the ≥ 70-year subgroup, DT (vs TEG) remained independently associated with postoperative complications (OR 3.57, 95% CI 1.03–12.41; P = 0.045). Conversely, DT demonstrated superior anti-reflux outcomes, including lower GerdQ scores and lower reflux esophagitis rates at 12 and 24&#xa0;months (all P &lt; 0.05). DT also showed lower anastomotic stenosis at 3&#xa0;months (4.0% vs 11.4%, P = 0.038) and better long-term QoL regarding food intake and meal-related distress.</p> Conclusions <p>DT offers superior reflux control and long-term QoL outcomes. However, in patients aged ≥ 70&#xa0;years, TEG demonstrated a perioperative safety advantage, driven mainly by a lower rate of non-anastomosis-related complications. Reconstruction choice in older patients should be individualized by balancing perioperative risks and long-term functional benefits.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Age-dependent trade-offs between tubular esophagogastric and double-tract anastomosis after laparoscopic proximal gastrectomy: a retrospective cohort study

  • 期刊论文

  • 发表日期：

    2026年3月9日

查看全文
  • Meng Wei,
  • Zepeng Yan,
  • Zewei Cheng,
  • Chaoqun Wang,
  • Jun Ouyang,
  • Yadi Huang,
  • Chuanqi Chen,
  • Menghui Wang,
  • Yongqi Yan,
  • Yangjia Li,
  • Honglei Wang,
  • Yihang Xu,
  • Zhibo Yan,
  • Wenbin Yu

摘要

Background

Optimal reconstruction after laparoscopic proximal gastrectomy (LPG) remains debated. This study compared perioperative outcomes and long-term quality of life (QoL) between tubular esophagogastric (TEG) and double-tract (DT) anastomosis, with attention to age-dependent effects.

Methods

This retrospective cohort study included 284 patients undergoing LPG with TEG or DT. Exploratory age-stratified analyses were performed. QoL was evaluated using GerdQ, dysphagia scores, and the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).

Results

DT was associated with longer operative time than TEG (232.1 vs 217.6 min, P = 0.016), primarily due to prolonged reconstruction time (90.3 vs 66.0 min, P < 0.001). In an exploratory analysis of patients aged ≥ 70 years, TEG was associated with fewer overall complications than DT (25.9% vs 50.0%, P = 0.049), while complication severity by Clavien–Dindo grade was comparable between groups. This divergence was primarily attributable to non-anastomosis-related complications rather than anastomotic events. In multivariable analysis within the ≥ 70-year subgroup, DT (vs TEG) remained independently associated with postoperative complications (OR 3.57, 95% CI 1.03–12.41; P = 0.045). Conversely, DT demonstrated superior anti-reflux outcomes, including lower GerdQ scores and lower reflux esophagitis rates at 12 and 24 months (all P < 0.05). DT also showed lower anastomotic stenosis at 3 months (4.0% vs 11.4%, P = 0.038) and better long-term QoL regarding food intake and meal-related distress.

Conclusions

DT offers superior reflux control and long-term QoL outcomes. However, in patients aged ≥ 70 years, TEG demonstrated a perioperative safety advantage, driven mainly by a lower rate of non-anastomosis-related complications. Reconstruction choice in older patients should be individualized by balancing perioperative risks and long-term functional benefits.

Graphical Abstract