Clinical evaluation of right-sided overlap with single flap valvuloplasty and double tract reconstruction after proximal gastrectomy

Right-sided overlap with single flap valvuloplasty (ROSF) is an anti-reflux technique first described by our center for direct esophagogastric anastomosis after proximal gastrectomy (PG). This single-center retrospective study aimed to compare the surgical safety, short-term, and medium-term outcomes of ROSF versus double tract reconstruction (DTR) in patients undergoing PG for adenocarcinoma of the esophagogastric junction (AEG). Patients with Siewert type II/III AEG who underwent laparoscopic proximal gastrectomy (LPG) at the Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, from January 2017 to December 2022 were enrolled. Based on the digestive tract reconstruction method, patients were stratified into the ROSF group (n = 43) and DTR group (n = 51). Propensity score matching (PSM) was performed using a 1:1 nearest-neighbor approach with a caliper value of 20% of the propensity score standard deviation, incorporating age, gender, tumor diameter, Siewert classification, clinical T stage, and preoperative L3 skeletal muscle index (L3-SMI) to balance baseline characteristics. A total of 60 patients (30 per group) after propensity score matching (PSM) were included in the final analysis. Postoperative follow-up data (up to 2 years) were analyzed to compare the two groups’ surgical/perioperative parameters, postoperative complications, and serological nutritional indicators. Before PSM, tumor diameter differed significantly between the two groups (P < 0.05); this difference was eliminated after matching (n = 30 per Group, P > 0.05). Compared with the DTR group, ROSF was associated with significantly faster postoperative recovery and better preservation of nutritional parameters and body composition at 1–2 years compared to DTR (all P < 0.05): time to first liquid intake (3.34 ± 1.45 days in ROSF vs. 5.10 ± 2.76 days in DTR), duration of gastric tube retention (0.86 ± 2.49 days in ROSF vs. 4.19 ± 5.15 days in DTR)., time to removal of the posterior anastomotic drain (9.34 ± 3.38 days in ROSF vs. 14.74 ± 12.96 days in DTR), total hospital stay (10.53 ± 4.45 days in ROSF vs. 15.87 ± 13.82 days in DTR), postoperative prealbumin levels at 18 and 24 months, weight loss percentage from 9 months to 2 years postoperatively, body mass index (BMI) from 1 to 2 years postoperatively, and L3 skeletal muscle index (SMI) at 1 year postoperatively. The two groups had no significant differences in postoperative complications or other nutritional indicators (all P > 0.05). For Siewert type II/III AEG meeting surgical indications, ROSF and DTR are feasible reconstruction options after radical PG. ROSF shows promising medium-term (1–2 year) benefits in perioperative recovery and nutritional preservation, and a lower trend of intestinal obstruction, suggesting it is a valuable alternative reconstruction technique for eligible patients.