Qiu TH, Wen HY, Chen MM. Effect of double-tract reconstruction and laparoscopic proximal gastrectomy on immune function and stress. World J Gastrointest Surg 2025; 17(6): 104192 [DOI: 10.4240/wjgs.v17.i6.104192]
Corresponding Author of This Article
Ti-Hong Qiu, MD, Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Chengdu Medical College, Pidu District People’s Hospital, No. 666 the Second Section of Deyuan North Road, Pidu District, Chengdu 611730, Sichuan Province, China. 19382136238@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
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. Jun 27, 2025; 17(6): 104192 Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.104192
Effect of double-tract reconstruction and laparoscopic proximal gastrectomy on immune function and stress
Ti-Hong Qiu, Hong-You Wen, Ming-Ming Chen
Ti-Hong Qiu, Hong-You Wen, Ming-Ming Chen, Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Chengdu Medical College, Pidu District People’s Hospital, Chengdu 611730, Sichuan Province, China
Author contributions: Qiu TH designed the research and wrote the first manuscript; Qiu TH and Wen HY contributed to conceiving the research and analyzing data; Qiu TH and Chen MM conducted the analysis and provided guidance for the research; and all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of the Third Affiliated Hospital of Chengdu Medical College, Pidu District People’s Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
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: Ti-Hong Qiu, MD, Department of Gastrointestinal Surgery, The Third Affiliated Hospital of Chengdu Medical College, Pidu District People’s Hospital, No. 666 the Second Section of Deyuan North Road, Pidu District, Chengdu 611730, Sichuan Province, China. 19382136238@163.com
Received: February 12, 2025 Revised: March 7, 2025 Accepted: May 7, 2025 Published online: June 27, 2025 Processing time: 107 Days and 3.3 Hours
Abstract
BACKGROUND
Although surgery remains the primary treatment for proximal gastric cancer (PGC), ongoing refinements in surgical strategies are essential to improving clinical outcomes.
AIM
To investigate the effect of double-tract reconstruction (DTR) on immune function and stress response in patients undergoing laparoscopic proximal gastrectomy (LPG).
METHODS
In total, 78 patients with PGC admitted between August 2020 and August 2024 were enrolled. The research group consisted of 39 patients who underwent DTR + LPG, whereas the control group comprised 39 patients who underwent laparoscopic total gastrectomy with Roux-en-Y esophagojejunostomy. Perioperative indices (intraoperative blood loss, digestive tract anastomosis time, and time to first postoperative flatus), postoperative complications (intestinal obstruction, anastomotic ulcer, diarrhea, dumping syndrome, and gastroesophageal reflux), nutritional parameters (serum albumin, hemoglobin, and body mass index), immune function [immunoglobulin (Ig) G, IgA, and IgM), and stress response indicators (C-reactive protein, interleukin-6, and tumor necrosis factor-α) were collected and analyzed for both groups.
RESULTS
The intraoperative blood loss was lower (P < 0.05), and the time to first postoperative flatus time was shorter (P < 0.001) in the research group than in the control group. The two groups had comparable digestive tract anastomosis time (P > 0.05). The overall complication rate was significantly lower in the research group than in the control group (P = 0.042). Compared with the control group, the research group exhibited notably higher albumin, hemoglobin, and body mass index levels at 2 and 3 months postoperatively, as well as considerably high immunoglobulin (Ig) G, IgA, and IgM levels on postoperative day 1 (P < 0.05). The postoperative levels of C-reactive protein, interleukin-6, and tumor necrosis factor-α were also lower in the research group than in the control group (P < 0.001).
CONCLUSION
The combination of DTR and LPG in the treatment of patients with PGC is more effective in enhancing immune function and suppressing stress responses, showing more advantages over laparoscopic total gastrectomy.
Core Tip: This study focused on patients with proximal gastric cancer (PGC), enrolling 78 cases to compare the clinical outcomes of two digestive reconstruction techniques: Double-tract reconstruction following laparoscopic proximal gastrectomy vs Roux-en-Y esophagojejunostomy following laparoscopic total gastrectomy, and optimize therapeutic strategies for PGC. The results demonstrate that double-tract reconstruction + laparoscopic proximal gastrectomy offers superior clinical benefits to laparoscopic total gastrectomy + Roux-en-Y reconstruction, including reduced intraoperative blood loss, a shorter time to first postoperative flatus (indicating faster postoperative recovery), enhanced safety, improved preservation of nutritional status and immune function, and a mitigated postoperative stress response. This study provides critical insights for refining surgical protocols in PGC management.
