Does different surgical approaches affect tolerance to postoperative adjuvant chemotherapy in early-stage upper gastric cancer?

OBJECTIVE

To compare the effects of laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) vs. laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) on tolerance to postoperative adjuvant chemotherapy in early-stage upper gastric cancer, providing evidence for surgical strategy selection and its impact on chemotherapy outcomes.

METHODS

In this retrospective cohort study, clinical data were collected from 76 patients with early-stage upper gastric cancer who underwent postoperative chemotherapy following either LPG-DTR or LTG-RY at our institution between January 2020 and January 2023. Patients were stratified into the DTR group (n = 35) and RY group (n = 41) based on surgical approach and digestive reconstruction.

RESULTS

Compared with the R-Y group, the DTR group had a longer operation time, and a smaller number of lymph node dissections (all P < 0.05).Chemotherapy completion rates showed no significant intergroup difference (all P > 0.05).The DTR group demonstrated:Lower incidence of grade ≥2 adverse events (per CTCAE v5.0 criteria), Reduced requirement for granulocyte colony-stimulating factor (G-CSF)Increased utilization of antiemetics (e.g., ondansetron, azasetron) (all P < 0.05).

CONCLUSION

LPG-DTR is associated with attenuated myelosuppression and decreased incidence of specific chemotherapy-related toxicities (thrombocytopenia, hepatotoxicity, peripheral neuropathy). Preservation of partial gastric function may underlie these advantages and potentially improve quality of life during adjuvant treatment.