Double tract reconstruction in proximal gastric tumors: A systematic review of clinical and functional outcomes

Table 1 Single- and multicenter studies comparing proximal gastrectomy-double tract reconstruction with total gastrectomy-Roux-en-Y and proximal gastrectomy-esophagogastrostomy

Ref.	Country	Year	Study period	Study design	Group	Sample size	Patients per group (n)	Age	Sex (male/female)	Preoperative BMI (kg/m2)	Access (% minimally invasive procedures)	Operation duration (minutes)	Bleeding (mL)	Retrieved lymph nodes (n)	Early complication (Clavien-Dindo ≥ 3)	Lenght of stay hospital (days)	TNM stage (I/II/III)	Reflux esophagitis (n)	Mean BMI difference (kg/m2)	Follow up (month)	Survival data
Kim and Kim[7]	Korea	2016	2009-2014	Retrospective	DTR	34	17	64.7 ± 9.9	14/3	24.2 ± 3.8	Laparoscopic	268.2 ± 40.9		33.4 ± 17.3	3	9.4 ± 4.1	16/1/0	2		12
					TG-RNY		17	60.9 ± 12.9	10/7	23.4 ± 5		270 ± 43.4		39.3 ± 20.4	3	10 ± 3.6	15/2/0	1		12
Jung et al[8]	Korea	2017	2008-2016	Retrospective	DTR	248	92	59.8 ± 11.4	77/15	23.5 ± 2.7	Laparoscopic	198.3 ± 38.8	84.7 ± 81.7	46.1 ± 19.6		8.5 ± 11.3		1	DTR < TGRY	26.6 ± 10.3	The 5-year OS rate; 96.1% and 95.9% for the PG-DTR and TG groups, respectively (P = 0.575)
					TG-RNY		156	58.7 ± 10.8	120/36	23.9 ± 3.3		225.4 ± 51.6	128.3 ± 112.5	60.0 ± 25.7		8.6 ± 5.7		3		43.5 ± 23.2
Ko et al[9]	Korea	2020	2008-2016	Retrospective	DTR	104	52	61.5 ± 12.3	35/17	23.7 ± 3.1	Laparoscopic	206.1 ± 38.2	133.6 ± 138.6	26.5 ± 11.1	4	13.3 ± 8.6	45/5/2	1		22.7 ± 15.4	The PG-DTR group had a significantly better 5-year OS rate than the TG group (P = 0.02)
					TG-RNY		52	63.0 ± 9.2	35/17	23.4 ± 2.9		204.2 ± 47.5	167.3 ± 94.4	36.2 ± 16.5	7	18.0 ± 15.5	40/7/5	0		36.3 ± 23.1
Li et al[10]	China	2019	2015-2017	RCT	DTR	300	103		90/13	66.10 ± 3.618 (kg)	Open	143.62 ± 2.98	140.22 ± 7.93	23 ± 3	0	10.52 ± 1.18	87/16/0	9	2.02 kg	18
					JI		98		88/10	66.33 ± 3.116 (kg)		144.37 ± 2.51	139.09 ± 8.85	22 ± 3	1	10.53 ± 1.31	81/17/0	4	1.78 kg	18
					TG-RNY		99		82/17	66.36 ± 3.824 (kg)		143.29 ± 4.51	139.78 ± 8.52	37 ± 4	1	10.68 ± 1.35	78/21/0	11	8.11 kg	18
Ji et al[11]	China	2021	2014-2019	Retrospective	DTR	64	25	64.5 ± 8.9	24/1	24.5 ± 2.6	Open	240 (210-270)	50 (50-100)	19 (16.3-23)	0	13 (11-18)	23/2/0	2		39.8	The 3-year OS rates of the EG and PG-DTR groups were 79.9% and 90.9%, respectively (P = 0.066)
					EG		39	62.1 ± 9.1	31/8	24.5 ± 3.7		195 (170-240)	100 (50-100)	22.5 (17-31)	1	11 (10-14)	21/12/6	12	N	39.8
Ma et al[12]	China	2020	2010-2018	PSM	DTR	192	86	60.5 ± 8.2	79/7		Laparoscopic/open: 61/25	177 ± 30	91 ± 32	23 ± 6	2	11.3 ± 3.4	31/27/28		8.8 kg	48	5 year OS rates in pathological stage II; PG-DTR and TG-RNY were 71.5% and 65.3%, respectively (P = 0.365)
					TG-RNY		86	62,7 ± 10,5	76/10		Laparoscopic/open: 57/29	164 ± 17	106 ± 62	25 ± 7	3	10.5 ± 2.1	35/22/29		12.7 kg	48	5-year OS rates in pathological stage III; PG-DTR and TG-RNY were 51.9% and 42.1%, respectively (P = 0.272)
Wang et al[13]	China	2020	2016-2017	Retrospective	DTR	36	12	55.8 ± 4.1	6/6	23.29 ± 0.76	Laparoscopic	215.8 ± 14.69	104.2 ± 14.38	28.50 ± 3.76	0	10.8 ± 1.19	10/2/0	1	DTR < TGRY	12
					TG-RNY		24	58.38 ± 1.82	15/9	23.5 ± 0.68		209.3 ± 12.87	111.7 ± 12.2	36.29 ± 1.35	0	13.0 ± 2.1	22/2/0	11		12
Sato et al[14]	Japan	2021	2013-2019	Retrospective	DTR	150	75	68.8 ± 10.2	59/16	22.4 (15.8-32.2)	Laparoscopic/robot: 65/10	312 (199-552)	23 (4-192)		9	9 (7-58)	60/11/4	6		36.3 (22.2-51.0)
					TG-RNY		75	66.2 ± 11.8	51/24	22.8 (16.0-34.8)	Laparoscopic/robot: 64/11	311 (206-495)	25 (3-182)		4	9 (7-49)	44/16/12	4		36.3 (22.2-51.0)
Kimuro et al[15]	Japan	2021	2011-2018	Retrospective	DTR	16	8	70.4 (55-77)	8/0	22.9 (19.3-24.9)	Laparoscopic	294.1 ± 33.9	8.2 ± 4.3		2	15.4 ± 3.3	8/0/0		92 ± 5.7 (weight 24th month)	24
					TG-RNY		8	68.3 (45-83)	8/0	23.7 (20.8-29.8)		383.4 ± 20.7	48.8 ± 16.8		1	14.6 ± 2.2	8/0/0		82.4 ± 3.7 (weight 24th month)	24
Eom et al[16]	Korea	2021	2013-2017	Retrospective	DTR	103	58	65.5 (52.8-72.0)	47/11	23.5 ± 3.1	Laparoscopic			34.0 (24.6-40.3)				2	There is no significant difference	12
					EG		45	63.0 (53.5-72.5)	13/12	25.0 ± 3.3				26.0 (20.5-36.5)				8		12
Hwang et al[17]	Korea	2022	2016-2018	RCT	DTR	128	63	58.6 ± 10.2	35/28	24.5 ± 2.9	Laparoscopic	217.1 ± 67.5	75.5 ± 74.7	40.8 ± 18.3	3	7.4 ± 3.2	60/3/0	9		0.5
					TG-RNY		65	61.3 ± 11.5	47/18	24.5 ± 2.9		200.8 ± 51.9	65.5 ± 62.7	55.1 ± 24.9	2	7.3 ± 2.9	58/7/0	9		0.5
Li et al[18]	China	2023	2012-2015	Retrospective	DTR	100	50	65.8 ± 4.5	40/10	24.1 ± 1.8	Laparoscopic	192.1 ± 7.7	122.4 ± 45.8	25.7 ± 4.6	3	14.1 ± 4.4	50/0/0	1	22.9 ± 2.0 (BMI: 12nd month)	60	5-year OS rates in the PG-DTR and TG-RNY were 98% and 90%, respectively (P = 0.08)
					TG-RNY		50	66.9 ± 3.6	40/10	23.8 ± 2.0		187.4 ± 6.7	117.0 ± 51.3	34.4 ± 5.2	2	14.6 ± 6.0	50/0/0	2	20.6 ± 1.3	60
Ma et al[19]	China	2022	2013-2018	Retrospective	DTR	66	33	23 patients (> 60 years)	28/5		Laparoscopic	204 ± 37	171 ± 71	21.5 ± 9.5	3	15.4 ± 2.3	14/9/10	8	DTR < TGRY	54	5-year OS rates in the PG-DTR and TG groups were 61% and 60%, respectively (P = 0.61)
					TG-RNY		33	21 patients (> 60 years)	28/5			205 ± 50	176 ± 96	29.0 ± 10.9	3	17.2 ± 3.8	10/12/11	11		61
Park et al[20]	Korea	2023	2016-2020	RCT	DTR	128	63	58.6 ± 10.3	35/28	24.5 ± 2.9	Laparoscopic	217.1 ± 67.5	75.5 ± 74.6	40.8 ± 18.3		7.4 ± 3.2	60/3/0	1		24	2-year OS rates; PG-DTR and TG-RNY were 98.5% and 100%, respectively (P = 0.33)
					TG-RNY		65	61.3 ± 11.5	47/18	24.5 ± 2.9		200.8 ± 51.9	65.5 ± 62.7	55.1 ± 24.9		7.3 ± 2.9	58/7/0	2		24
Hasegawa et al[21]	Japan	2024	2011-2022	Retrospective	DTR	73	39	66.6 ± 14.0	27/12	22.3 ± 3.0	Laparoscopic/robot/open: 21/11/2	404.5 ± 88.8	114.8 ± 143.9	23.6 ± 12.5	6	16.1 ± 10.9	30/6/3	0	There is no significant difference	36
					EG		34	69.4 ± 9.9	27/7	23.0 ± 3.6	Laparoscopic/robot/open: 24/15/0	365.1 ± 99.5	122.3 ± 195.5	23.9 ± 13.9	2	15.8 ± 12.6	29/4/1	5		36
Shoda et al[22]	Japan	2024	2020-2022	Prospective	DTR	20	10	72.3 ± 6.3	9/1	24.0 ± 2.9	Laparoscopic	554.6 ± 163.2	123.8 ± 118.3		0	14.6 ± 3.8	5/0/5		0.17 ± 0.08	12
					EG		10	68.8 ± 8.9	6/4	23.0 ± 4.2		413.5 ± 91.2	78.7 ± 75.8		0	12.0 ± 6.7	8/1/1		0.14 ± 0.08	12
Wang et al[23]	China	2024	2020-2022	Retrospective	DTR	295	87	64.8 ± 6.67	69/18	24.24 ± 3.27	Laparoscopic	230 (210-255)	85 (50-100)	22 (19-31)	2	7 (7-9)	30/22/35	8	2.51 ± 1.38	12
					EG		96	64.8 ± 6.62	74/22	23.79 ± 2.79		195 (180-250)	100 (50-100)	21 (18-26)	1	8 (7-9)	26/21/49	42	4.37 ± 1.81	12
					TG-RNY		112	63.15 ± 9.64	81/31	24.75 ± 3.36		200 (180-240)	100 (50-100)	28 (22-35)	4	8 (7-9)	23/26/63	26	3.96 ± 1.59	12
Sun et al[24]	China	2024	2019-2023	Retrospective	DTR	156	93	63.16 ± 9.75	74/19	23.08 ± 3.64	Laparoscopic	166.38	113.23	18.10	5	13.83		33	1.40 ± 0.655	12
					EG		63	61.70 ± 8.30	47/16	23.20 ± 3.39		174.06	150.16	16.81	5	13.11		49	1.81 ± 0.759	12
Wu et al[25]	China	2024	2020-2022	Retrospective	DTR	43	23	70 (66-76)	19/4	22.1 ± 2.8	Laparoscopic	187 (177-198)	21.2 ± 4.1	20.4 ± 10.3	0	8 (8-9)	15/8/0	9	22.3 ± 2.6 (BMI: 12nd month)	12
					SOA		20	65.5 (60.8-71.8)	17/3	21.9 ± 3.3		197.5 (190-207)	21.9 ± 3.0	24.8 ± 11.0	0	8.0 (7.0-8.8)	16/4/0	2	22.0 ± 2.5	12

BMI: Body mass index; TNM: Tumor-node-metastasis; RCT: Randomized controlled trial; PSM: Propensity score-matched; PG: Proximal gastrectomy; DTR: Double tract reconstruction; TG: Total gastrectomy; RNY: Roux-en-Y; EG: Esophagogastrostomy; JI: Jejunal interposition; SOA: Stomach outlet anastomosis; OS: Overall survival.