S3178 Double-Tract Versus Esophagogastrostomy Reconstruction After Proximal Gastrectomy: Which Method Wins on Outcomes? A Systematic Review and Meta-Analysis

Introduction: Proximal gastrectomy (PG) is a treatment option for early-stage gastric cancer in the upper one-third of the stomach. The optimal reconstruction method after PG remains a topic of debate. This meta-analysis aimed to compare the surgical outcomes of the double-tract reconstruction (DTR) and esophagogastrostomy (EG) reconstruction methods after PG. Methods: Electronic databases like PubMed, Cochrane Central, and ScienceDirect were searched from inception until January 2025. This review adhered closely to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI) were pooled under the random effects model using the Review Manager software version 5.4.1 for the dichotomous and continuous outcomes. The primary and secondary endpoints of interest were reflux esophagitis, anastomotic stricture, anastomotic leakage, operative time (min), intraoperative blood loss (ml), and postoperative hospital stay (days). Quality assessment was done through the Cochrane Risk of Bias (RoB) 2.0 tool and the Newcastle Ottawa Scale. Publication bias was assessed visually through funnel plots and statistically through Egger’s regression test. Leave-one-out sensitivity analysis was conducted to assess the source of heterogeneity. Results: Eleven studies pooling a total of 744 patients were included in this meta-analysis. DTR significantly decreased reflux esophagitis compared to EG (RR = 0.25; 95% CI 0.17-0.35; P < 0.00001; I2 = 0%). DTR was also associated with a lower risk of anastomotic stricture (RR = 0.25; 95% CI 0.11-0.54; P = 0.0004; I2 = 15%) and a longer operating time (MD = 29.73 min; 95% CI 19.76-39.71; P < 0.00001; I2 = 7%). Other outcomes including the anastomotic leakage (RR = 0.75; 95% CI 0.42-1.36; P = 0.34; I2 = 0%), intraoperative blood loss (MD = 2.99 ml; 95% CI:-5.00-10.99; P = 0.46; I2 = 0%), and postoperative hospital stay (MD = 0.33 days; 95% CI -0.60-1.27; P = 0.48; I2 = 47%) were comparable between the DTR and EG groups. Conclusion: The DTR group showed a lower risk of reflux esophagitis and anastomotic stricture with a longer operating time. Other outcomes including the anastomotic leakage, intraoperative blood loss and postoperative hospital stay were comparable between the 2 reconstruction techniques. These findings suggest DTR offers better functional outcomes and may be preferred for reducing postoperative complications.