Effect of double-tract reconstruction and laparoscopic proximal gastrectomy on immune function and stress

Abstract

BACKGROUND

Although surgery remains the primary treatment for proximal gastric cancer (PGC), ongoing refinements in surgical strategies are essential to improving clinical outcomes.

AIM

To investigate the effect of double-tract reconstruction (DTR) on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy (LPG).

METHODS

In total, 78 patients with PGC admitted between August 2020 and August 2024 were enrolled. The research group consisted of 39 patients who underwent DTR + LPG, whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy. Perioperative indices (intraoperative blood loss, digestive tract anastomosis time, and time to first postoperative flatus), postoperative complications (intestinal obstruction, anastomotic ulcer, diarrhea, dumping syndrome, and gastroesophageal reflux), nutritional parameters (serum albumin, hemoglobin, and body mass index), immune function [immunoglobulin (Ig) G, IgA, and IgM), and stress response indicators (C-reactive protein, interleukin-6, and tumor necrosis factor-α) were collected and analyzed for both groups.

RESULTS

The intraoperative blood loss was lower (P < 0.05), and the time to first postoperative flatus time was shorter (P < 0.001) in the research group than in the control group. The two groups had comparable digestive tract anastomosis time (P > 0.05). The overall complication rate was significantly lower in the research group than in the control group (P = 0.042). Compared with the control group, the research group exhibited notably higher albumin, hemoglobin, and body mass index levels at 2 and 3 months postoperatively, as well as considerably high immunoglobulin (Ig) G, IgA, and IgM levels on postoperative day 1 (P < 0.05). The postoperative levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were also lower in the research group than in the control group (P < 0.001).

CONCLUSION

The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses, showing more advantages over laparoscopic total gastrectomy.

Keywords: Double-tract reconstruction; Laparoscopic proximal gastrectomy; Immune function; Stress response; Clinical research

Core Tip: This study focused on patients with proximal gastric cancer (PGC), enrolling 78 cases to compare the clinical outcomes of two digestive reconstruction techniques: Double-tract reconstruction following laparoscopic proximal gastrectomy vs Roux-en-Y esophagojejunostomy following laparoscopic total gastrectomy, and optimize therapeutic strategies for PGC. The results demonstrate that double-tract reconstruction + laparoscopic proximal gastrectomy offers superior clinical benefits to laparoscopic total gastrectomy + Roux-en-Y reconstruction, including reduced intraoperative blood loss, a shorter time to first postoperative flatus (indicating faster postoperative recovery), enhanced safety, improved preservation of nutritional status and immune function, and a mitigated postoperative stress response. This study provides critical insights for refining surgical protocols in PGC management.