392 Optimizing Reconstructive Approaches to Improve Function and Quality of Life After Esophagectomy & Gastrectomy (ORACLE-1)

Abstract Introduction Surgery for oesophageal and gastric cancer may be associated with nutritional consequences and impaired gastrointestinal quality of life in long term survivorship. Little is known regarding international variations in reconstructive practice and impact on functional outcomes Aim To characterise international variation in reconstructive approach during oesophagogastric cancer surgery. Method An electronic survey was distributed to consultant surgeons performing oesophagectomy or gastrectomy. The survey collected data on respondents’ practice setting, reconstructive techniques, postoperative regimens, and management of functional complications. Invitations to participate were circulated by the ISDE, IGCA, UKIOG and via Trinity St James’s Cancer Institute mailing lists. Consent was obtained from all participants. Results A total of 140 responses were received from consultant surgeons representing 107 centres across 33 countries. Most respondents (122, 87%) practiced in university or academic hospitals. Pyloric management strategies included: pyloroplasty (17%), balloon dilatation (13%), pyloromyotomy (11%), prokinetic medication (11%), botulinum toxin injection (7%), and finger fracture (6%), while 52% used no routine intervention. Radiographic contrast studies were utilised by 45% routinely following oesophagectomy. Initiation of oral intake ranged from the day of surgery to postoperative day 14, and discharge diets varied from liquids to full normal diets. For Roux-en-Y reconstruction after gastrectomy, 55% favoured a retrocolic approach and 45% an antecolic route. Proximal gastrectomy was performed by 33% of respondents. Conclusions This study highlights considerable heterogeneity in practice. Further research may identify optimal reconstructive techniques and could improve functional outcomes.