Short-term outcomes of a novel anti-reflux biologic flap technique versus double flap technique after laparoscopic proximal gastrectomy: a retrospective cohort study - Report - MDSpire
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Short-Term Outcomes After Laparoscopic Proximal Gastrectomy: Comparing a Novel Anti-Reflux Biologic Flap With the Double-Flap Technique in a Retrospective Cohort Study
Clinical Report: Short-Term Outcomes After Laparoscopic Proximal Gastrectomy
Overview
This retrospective cohort study compares a novel biologic flap technique (BFT) with the double-flap technique (DFT) for reconstruction after laparoscopic proximal gastrectomy. The supplied article material describes the study rationale, eligibility criteria, and operative methods but does not provide cohort size or comparative outcome results; therefore, relative short-term safety or efficacy cannot be summarized.
Background
Proximal gastrectomy is described as a function-preserving alternative to total gastrectomy for selected patients with proximal gastric cancer, with reported survival comparable to total gastrectomy and better long-term nutritional preservation. Postoperative reflux esophagitis is a concern after proximal gastrectomy, particularly with simple esophagogastrostomy, for which the source reports an incidence as high as 27.3%. DFT is described as having strong anti-reflux efficacy, but it is technically demanding and carries a risk of anastomotic stenosis. BFT was developed using a porcine small intestinal submucosa patch intended to form a mechanical anti-reflux barrier around the lower esophagus and anastomosis.
Data Highlights
Item
Source-reported detail
Study design and setting
Retrospective review of consecutive patients at the First Affiliated Hospital of Xi’an Jiaotong University, January 2020–June 2024
Eligibility
Histologically confirmed gastric adenocarcinoma; laparoscopic proximal gastrectomy with BFT or DFT; R0 resection
Exclusions
Neoadjuvant therapy; emergency surgery for tumor-related bleeding, perforation, or obstruction; other malignant tumors
Operative approach
Routine D1+ lymphadenectomy; additional stations No. 19, 20, and 110 dissected when esophageal invasion was present
Esophageal margin
Proximal margin of at least 2 cm; frozen-section examination when required
Reconstruction selection
DFT generally used when about two-thirds of the stomach could be retained and the resected abdominal esophageal segment was less than 2 cm; BFT was introduced in April 2023
Comparative outcome results
Not included in the supplied article material
Key Findings
The study retrospectively assessed patients undergoing laparoscopic proximal gastrectomy with BFT or DFT between January 2020 and June 2024; the supplied material does not state the number of patients.
Patients were required to have histologically confirmed gastric adenocarcinoma and an R0 resection; patients receiving neoadjuvant therapy or emergency surgery for tumor-related complications were excluded.
BFT uses a porcine small intestinal submucosa patch to create a proposed mechanical anti-reflux barrier around the lower esophagus and anastomosis.
The source describes DFT as having strong anti-reflux efficacy, while noting its technical difficulty and risk of postoperative anastomotic stenosis.
DFT was generally selected when approximately two-thirds of the stomach could be preserved and the resected abdominal esophageal segment was less than 2 cm; BFT, introduced in April 2023, had partially overlapping indications.
A related 2019 ASCO meeting abstract is titled “Impact of double-flap technique for reconstruction after proximal gastrectomy,” but the supplied context provides no abstract findings to report.
Clinical Implications
The supplied material describes BFT as an alternative reconstruction with indications that partially overlap those of DFT, but it does not provide comparative short-term outcome data. No conclusion about relative reflux control, complications, or clinical suitability can be drawn from the information provided.
Conclusion
The article presents the rationale and operative framework for comparing BFT with DFT after laparoscopic proximal gastrectomy. Comparative results are absent from the supplied material, limiting assessment of short-term outcomes.
by Lindi Cai, Guanglin Qiu, Pengwei Zhao, Gan Li, Junxiang Zhang, Enmeng Li, Yongtai Ma, Yanjun Sun, Mengke Zhu, Xinhua Liao, Xiangming Che, Xuqi Li, Lin Fan
