ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2026
Reflux and stenosis after minimally invasive proximal gastrectomy with double-flap technique: risk factors and impact of robotic surgery.
Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundProximal gastrectomy (PG) with double-flap technique (DFT) is increasingly performed in East Asia as a function-preserving alternative to total gastrectomy. However, reflux esophagitis and anastomotic stenosis remain major concerns, and risk factors after minimally invasive approaches, including robotic surgery, have not been well defined.
methodsWe retrospectively analyzed 399 patients who underwent laparoscopic or robotic PG-DFT for esophagogastric junction (EGJ) or gastric cancers (GC) between 2009 and 2023. The primary endpoint was reflux esophagitis assessed by endoscopy at 1 year, and the secondary endpoint was anastomotic stenosis requiring balloon dilatation. Logistic regression analyses were performed to identify risk factors.
resultsReflux occurred in 24 patients (6.0%) and stenosis in 51 patients (12.8%). Independent risk factors were EGJ cancer or GC with esophageal invasion for reflux (odds ratio [OR] 3.21, 1.31–8.00) and a narrow esophageal diameter (< 18 mm) for stenosis (OR 11.97, 5.93–24.66). Moreover, robotic surgery was associated with a lower incidence of reflux compared with laparoscopic surgery in patients with EGJ cancer or GC with esophageal invasion. In patients with a narrow esophagus, shorter operative time was associated with a lower risk of stenosis.
conclusionsMinimally invasive PG-DFT carries distinct risks of reflux and stenosis depending on tumor and anatomical factors. Robotic surgery was associated with a lower incidence of reflux in high-risk patients, whereas technical proficiency and shorter operative time may be critical for preventing stenosis in patients with a narrow esophagus. These findings may support individualized strategies and selective use of robotics to optimize outcomes after PG.
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