Age-dependent trade-offs between tubular esophagogastric and double-tract anastomosis after laparoscopic proximal gastrectomy: a retrospective cohort study

Abstract

Background: Optimal reconstruction after laparoscopic proximal gastrectomy (LPG) remains debated. This study compared perioperative outcomes and long-term quality of life (QoL) between tubular esophagogastric (TEG) and double-tract (DT) anastomosis, with attention to age-dependent effects.

Methods: This retrospective cohort study included 284 patients undergoing LPG with TEG or DT. Exploratory age-stratified analyses were performed. QoL was evaluated using GerdQ, dysphagia scores, and the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).

Results: DT was associated with longer operative time than TEG (232.1 vs 217.6 min, P = 0.016), primarily due to prolonged reconstruction time (90.3 vs 66.0 min, P < 0.001). In an exploratory analysis of patients aged ≥ 70 years, TEG was associated with fewer overall complications than DT (25.9% vs 50.0%, P = 0.049), while complication severity by Clavien-Dindo grade was comparable between groups. This divergence was primarily attributable to non-anastomosis-related complications rather than anastomotic events. In multivariable analysis within the ≥ 70-year subgroup, DT (vs TEG) remained independently associated with postoperative complications (OR 3.57, 95% CI 1.03-12.41; P = 0.045). Conversely, DT demonstrated superior anti-reflux outcomes, including lower GerdQ scores and lower reflux esophagitis rates at 12 and 24 months (all P < 0.05). DT also showed lower anastomotic stenosis at 3 months (4.0% vs 11.4%, P = 0.038) and better long-term QoL regarding food intake and meal-related distress.

Conclusions: DT offers superior reflux control and long-term QoL outcomes. However, in patients aged ≥ 70 years, TEG demonstrated a perioperative safety advantage, driven mainly by a lower rate of non-anastomosis-related complications. Reconstruction choice in older patients should be individualized by balancing perioperative risks and long-term functional benefits.

Keywords: Double-tract anastomosis; Elderly patients; Gastric cancer; Laparoscopic proximal gastrectomy; Tubular esophagogastric anastomosis.