Ilhan E, Okut G. Double tract reconstruction in proximal gastric tumors: A systematic review of clinical and functional outcomes. World J Gastrointest Surg 2025; 17(9): 109030 [DOI: 10.4240/wjgs.v17.i9.109030]
Corresponding Author of This Article
Enver Ilhan, Full Professor, Department of General Surgery, Izmir Faculty of Medicine, University of Health Sciences Türkiye, Izmir City Hospital, Evket İnce Neighborhood, 2148/11 Street, No. 1/11, Izmir 35040, Türkiye. enverhan60@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Sep 27, 2025; 17(9): 109030 Published online Sep 27, 2025. doi: 10.4240/wjgs.v17.i9.109030
Double tract reconstruction in proximal gastric tumors: A systematic review of clinical and functional outcomes
Enver Ilhan, Gökalp Okut
Enver Ilhan, Department of General Surgery, Izmir Faculty of Medicine, University of Health Sciences Türkiye, Izmir City Hospital, Izmir 35040, Türkiye
Gökalp Okut, Department of Gastrointestinal Surgery, University of Health Sciences Türkiye, Izmir City Hospital, Izmir 35040, Türkiye
Co-first authors: Enver Ilhan and Gökalp Okut.
Author contributions: Ilhan E reviewed and edited the manuscript; Okut G wrote the manuscript; Ilhan E and Okut G contributed equally to this work as co-first authors. All authors approved the final version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Enver Ilhan, Full Professor, Department of General Surgery, Izmir Faculty of Medicine, University of Health Sciences Türkiye, Izmir City Hospital, Evket İnce Neighborhood, 2148/11 Street, No. 1/11, Izmir 35040, Türkiye. enverhan60@gmail.com
Received: April 28, 2025 Revised: May 27, 2025 Accepted: July 31, 2025 Published online: September 27, 2025 Processing time: 149 Days and 13.5 Hours
Abstract
BACKGROUND
Proximal gastrectomy (PG) with double tract reconstruction (DTR) has recently emerged as a function-preserving alternative to total gastrectomy (TG) with Roux-en-Y (RNY) reconstruction in patients with proximally located gastric cancer.
AIM
To evaluate the current evidence comparing PG-DTR with TG-RNY in terms of perioperative outcomes, long-term survival, complication rates, nutritional status and reflux esophagitis.
METHODS
A systematic literature search was conducted using PubMed, MEDLINE, Web of Science and the Cochrane Library for studies published between 2010 and January 2025. Search terms included gastric cancer, DTR and TG. Trials comparing PG-DTR with TG-RNY or PG-esophagogastrostomy (EG) were included. Data on operative details, lymph node yield, complications (Clavien-Dindo ≥ III), nutritional markers and incidence of reflux were extracted. Nineteen trials met the inclusion criteria. The review followed the PRISMA guidelines.
RESULTS
PG-DTR was found to have comparable long-term oncological outcomes to TG-RNY, despite a lower extent of lymph node dissection. Operative time and intraoperative blood loss were generally similar, with some studies favouring PG-DTR. Rates of major postoperative complications were comparable between techniques. Notably, PG-DTR showed a significantly lower incidence of reflux esophagitis than PG-EG and was comparable or superior to TG-RNY in reflux control. Nutritionally, PG-DTR was associated with better post-operative weight maintenance and biochemical parameters such as haemoglobin, albumin and vitamin B12 levels compared to TG-RNY. No significant nutritional differences were observed between PG-DTR and PG-EG. PG-DTR appears to offer a balanced approach to the surgical treatment of proximal gastric cancer, combining oncological safety with functional and nutritional benefits.
CONCLUSION
Its superiority over TG-RNY in postoperative nutrition and reflux prevention, together with comparable complication rates and survival, supports its consideration as a preferred reconstruction method in selected patients.
Core Tip: Proximal gastrectomy (PG) with double tract reconstruction (DTR) has gained attention as a function-preserving surgical technique for proximal gastric cancer. This systematic review demonstrates that PG-DTR achieves oncological outcomes comparable to total gastrectomy with Roux-en-Y reconstruction, while offering significant advantages in postoperative nutritional status. Preservation of the residual stomach and duodenum appears to play a critical role in minimizing weight loss and maintaining better haematological parameters. These findings suggest that PG-DTR may be a superior surgical option for selected patients without compromising oncological safety.
