Applications on proximal gastrectomy with gastroesophageal muscular flap anastomosis in laparoscopic surgery: a narrative review

In recent years, the detection rate of early upper gastric cancer has increased substantially, leading to improved overall patient prognosis and elevating postoperative quality of life to a key clinical priority. Consequently, function-preserving proximal gastrectomy has emerged as a promising surgical strategy. With the widespread adoption of minimally invasive techniques, laparoscopic proximal gastrectomy has become the standard approach; furthermore, the integration of robotic-assisted surgery has further refined the precision and feasibility of minimally invasive proximal gastrectomy. However, proximal gastrectomy frequently compromises the anatomical and functional integrity of the cardia and its surrounding structures, predisposing patients to postoperative gastroesophageal reflux—a major source of morbidity. To mitigate this complication, numerous digestive tract reconstruction methods have been proposed; yet, no consensus exists regarding the optimal technique. Accordingly, the development of an effective, evidence-based reconstruction method to minimize postoperative reflux remains the central challenge in proximal gastrectomy. Gastroesophageal muscular flap anastomosis is one such reconstructive approach designed to reduce reflux while preserving nutritional absorption. By creating a valve-like “artificial cardia” that permits unimpeded food passage, gastroesophageal muscular flap anastomosis aims to restore anti-reflux competence without compromising gastric emptying or intestinal transit. It is currently recommended as a preferred reconstruction strategy in laparoscopic proximal gastrectomy. The principal clinical questions surrounding gastroesophageal muscular flap anastomosis pertain to its efficacy and safety in preventing reflux, as well as its long-term impact on nutritional status and health-related quality of life. Current evidence suggests that gastroesophageal muscular flap anastomosis can significantly alleviate reflux-related symptoms and help maintain body weight and key nutritional parameters, with encouraging short-term outcomes reported across multiple studies. Nevertheless, existing clinical data are limited by methodological heterogeneity—including variations in surgical technique, definition of reflux endpoints, outcome assessment tools, and follow-up duration—thereby constraining the generalizability of current conclusions. Rigorous, multicenter, prospective randomized controlled trials with standardized protocols and long-term follow-up are warranted to validate the role of gastroesophageal muscular flap anastomosis in proximal gastrectomy.