Cancer Res Treat.  2021 Jul;53(3):784-794. 10.4143/crt.2020.1064.

Double Tract Reconstruction Reduces Reflux Esophagitis and Improves Quality of Life after Radical Proximal Gastrectomy for Patients with Upper Gastric or Esophagogastric Adenocarcinoma

• Ji X
• Jin C
• Ji K
• Zhang J
• Wu X
• Jia Z
• Bu Z
• Ji J

• KMID: 2518402
• DOI: http://doi.org/10.4143/crt.2020.1064

Abstract

Purpose
The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy.
Materials and Methods
Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study.
Results
Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score.
Conclusion
Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.

Keyword

Double tract reconstruction; Proximal gastrectomy; Reflux esophagitis; Quality of life

Figure

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  Fig. 1. Three-year overall survival curves of patients in the esophagogastrostomy and double tract reconstruction groups. The 3-year overall survival rates of the esophagogastrostomy and double tract reconstruction groups were 79.9% and 90.9%, respectively (p=0.066).

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  Fig. 2. Violin plots of global health status and functional scales of the EORTC QLQ-C30 questionnaire. Solid lines represent medians and dotted lines represent quartiles. A high score for global health status represented a high quality of life. A high score for a functional scale represented a healthy level of functioning. The patients in the DT group had better global health status (p < 0.001) and emotional functioning (p < 0.001) than those in the EG group. CF, cognitive functioning; DT, double tract reconstruction; EF, emotional functioning; EG, esophagogastrostomy; EORTC, European Organization for Research and Treatment of Cancer; PF, physical functioning; QL, global health status; RF, role functioning; SF, social functioning.

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  Fig. 3. Violin plots of the symptom scales of the EORTC QLQ-C30 questionnaire. Solid lines represent medians and dotted lines represent quartiles. A higher score represented worse symptoms. Patients in the DT group complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) than those in the EG group. AP, appetite loss; CO, constipation; DI, diarrhea; DT, double tract reconstruction; DY, dyspnea; EG, esophagogastrostomy; EORTC, European Organization for Research and Treatment of Cancer; FA, fatigue; FI, financial difficulties; NV, nausea and vomiting; PA, pain; SL, insomnia.

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  Fig. 4. Violin plots of the symptom scales of the EORTC QLQ-STO22 questionnaire. Solid lines represent medians and dotted lines represent quartiles. A higher score represented worse symptoms. Patients in the DT group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001) than those in the EG group. ANX, anxiety; BI, body image; DM, dry mouth; DT, double tract; DYS, dysphagia; EAT, eating; EG, esophagogastrostomy; EORTC, European Organization for Research and Treatment of Cancer; HAIR, hair loss; PAIN, pain; RFX, reflux; TA, taste.

Reference

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