Clinical Scorecard: Short-Term Outcomes After Laparoscopic Proximal Gastrectomy: Comparing a Novel Anti-Reflux Biologic Flap With the Double-Flap Technique in a Retrospective Cohort Study

At a Glance

Key Highlights

• The study retrospectively compared short-term outcomes after laparoscopic proximal gastrectomy with biologic flap technique (BFT) versus double-flap technique (DFT).
• BFT uses a porcine small intestinal submucosa patch to create a high-pressure zone around the lower esophagus and anastomotic site.
• DFT was generally selected when about two-thirds of the stomach could be retained and the resected abdominal esophageal segment was under 2 cm.
• BFT indications partially overlapped with DFT and included cases in which less than two-thirds of the stomach could be retained or abdominal esophageal resection exceeded 4 cm, particularly when DFT was technically difficult.
• The supplied article text describes the study rationale and methods but does not provide comparative outcome results.

Guideline-Based Recommendations

Diagnosis

Management

• Laparoscopic proximal gastrectomy and lymphadenectomy were conducted according to the Japanese Gastric Cancer Treatment Guidelines, version 6.
• Routine lymphadenectomy comprised D1+ stations; stations 19, 20, and 110 were additionally dissected when the tumor invaded the esophagus.
• The esophageal transection level was selected according to tumor location, maintaining a proximal margin of at least 2 cm; frozen-section examination was used when required to verify margin negativity.
• BFT and DFT were used for digestive tract reconstruction; the article excerpt does not report comparative outcome findings.

Monitoring & Follow-up

Risks

Patient & Prescribing Data

Consecutive patients treated from January 2020 through June 2024 at one hospital; eligible patients had histologically confirmed gastric adenocarcinoma, laparoscopic proximal gastrectomy with BFT or DFT, and R0 resection. Neoadjuvant therapy, emergency surgery for tumor-related bleeding, perforation, or obstruction, and other malignant tumors were exclusion criteria.

BFT was introduced in April 2023 as an alternative reconstruction. Potential candidates received preoperative information and gave informed consent. The excerpt provides no comparative short-term outcome data.

Clinical Best Practices

• The operations were performed by surgeons with more than 15 years of experience in laparoscopic gastric cancer procedures.
• The described BFT tubular stomach was 20 cm long and 3–4 cm wide.
• The study received institutional review board approval, with informed consent waived for the retrospective review; the study was registered in the Chinese Clinical Trial Registry.

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