Reconstruction methods after radical proximal gastrectomy: A systematic review

Background:The incidence of tumors located in the upper third of the stomach is increasing, and the use of radical proximal gastrectomy is becoming prevalent. After a proximal gastrectomy, various reconstructions are performed, but surgical outcomes are controversial. This study was performed to review clinical outcomes of reconstructions after proximal gastrectomy.Methods:Inclusion criteria focused on postoperative complications of patients who underwent a proximal gastrectomy for gastric cancer. Exclusion criteria were case reports; targeted data not investigated; a duplicate study reported in a larger cohort; esophageal sphincter preservation surgery; near-total gastrectomy; recurrence of tumor; and combined organ resection.Results:In total, 22 retrospective and 2 prospective studies were included. The studies investigated surgical outcomes of esophagogastrostomy (n=10), jejunal interposition (n=12), jejunal pouch interposition (n=7), double tract jejunal interposition (n=1), and tube-like stomach esophagogastrostomy (n=5). Pooled incidences of reflux esophagitis or reflux symptoms for these procedures were 28.6%, 4.5%, 12.9%, 4.7%, and 10.7%, respectively. Incidences of postoperative complications were 9.5%, 18.1%, 7.0%, 11.6%, and 9.3%, respectively.Conclusions:Despite increasing operation complexity, which perhaps increased the risk of other postoperative complications, currently used reconstructions present excellent anti-reflux efficacy. However, the optimal reconstruction method remains to be determined.