Surgical endoscopy · 2025
Uncut Roux-en-Y for very small remnant stomach in gastric cancer: surgical advantages and nutritional outcomes.
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Hong Wen-Qi, Hu Ren-Hao, Cui Xi-Mao, Jiang Xiao-Hua, Zhang Shun
Аннотация
BACKGROUND: The optimal reconstruction method after laparoscopic distal gastrectomy (LDG) for gastric cancer remains controversial. This study evaluates the novel approach of subtotal gastrectomy with preservation of a small remnant stomach (SRS) combined with uncut Roux-en-Y (URY) reconstruction, focusing on surgical feasibility, complications, and nutritional outcomes.
METHODS: A retrospective analysis of patients undergoing LDG (2017-2023) was conducted. To minimize selection bias between the URY (n = 175) and conventional Roux-en-Y (RY) (n = 69) groups, we performed 1:1 propensity score matching (PSM). Subgroup analysis was also conducted on URY patients, comparing those with SRS (n = 33) to those with a conventional remnant stomach (CRS) (n = 142), with PSM applied to this comparison as well.
RESULTS: After PSM, the baseline characteristics of the URY and RY groups (n = 49 each) were well-balanced. In the matched cohort, the URY group demonstrated significantly shorter operation time, less intraoperative blood loss, and shorter postoperative hospital stays compared to the RY group. Similarly, after matching, perioperative and nutritional outcomes were comparable between the SRS and CRS subgroups (n = 23 each).
CONCLUSION: After adjusting for baseline confounders using PSM, URY reconstruction is associated with significant surgical advantages over conventional RY. Furthermore, preserving an SRS with URY reconstruction is a safe, feasible, and surgically efficient approach, yielding short-to-intermediate term outcomes comparable to those with a conventional remnant.
METHODS: A retrospective analysis of patients undergoing LDG (2017-2023) was conducted. To minimize selection bias between the URY (n = 175) and conventional Roux-en-Y (RY) (n = 69) groups, we performed 1:1 propensity score matching (PSM). Subgroup analysis was also conducted on URY patients, comparing those with SRS (n = 33) to those with a conventional remnant stomach (CRS) (n = 142), with PSM applied to this comparison as well.
RESULTS: After PSM, the baseline characteristics of the URY and RY groups (n = 49 each) were well-balanced. In the matched cohort, the URY group demonstrated significantly shorter operation time, less intraoperative blood loss, and shorter postoperative hospital stays compared to the RY group. Similarly, after matching, perioperative and nutritional outcomes were comparable between the SRS and CRS subgroups (n = 23 each).
CONCLUSION: After adjusting for baseline confounders using PSM, URY reconstruction is associated with significant surgical advantages over conventional RY. Furthermore, preserving an SRS with URY reconstruction is a safe, feasible, and surgically efficient approach, yielding short-to-intermediate term outcomes comparable to those with a conventional remnant.