Background: Carcinoembryonic antigen (CEA) is one of the important indexes for the diagnosis and prognosis of gastrointestinal cancer. Systemic inflammatory response (SIR) is closely related to the occurrence and development of gastrointestinal cancer.

Purpose: Laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic proximal gastrectomy with tube-like stomach reconstruction (LPG-TLR) are both function-preserving procedures performed for treating AEG. However, there is no clinical consensus on the selection of digestive tract reconstruction after proximal gastrectomy, and the best way to reconstruct the digestive tract remains controversial. This study aimed at comparing the clinical outcomes of LPG-DTR and LPG-TLR to provide some reference to the choice of AEG surgical modalities.Methods: This was a multicenter, retrospective cohort study. we collected clinicopathological and follow-up data of patients with consecutive cases diagnosed with AEG from January 2016 to June 2021 in five medical centers. According to the way of digestive tract reconstruction after tumor resection, patients who underwent LPG-DTR or LPG-TLR were included in the present study. Propensity score matching (PSM) was performed to balance baseline variables that might affect the study outcomes. The QOL of the patients was evaluated using the Visick grade.Results: A total of 124 eligible consecutive cases were finally included. Patients in both groups were matched using the PSM method, and 55 patients from each group were included in the analysis after PSM. There was no statistically significant difference between the two groups in terms of the operation time, amount of intraoperative blood loss, days of postoperative abdominal drainage tube placement, postoperative hospitalization days, total hospitalization cost, the total number of lymph nodes cleared, and the number of positive lymph nodes (P>0.05). There was a statistically significant difference between the two groups in terms of time to first flatus after surgery and postoperative soft food recovery time (P<0.05). For the nutritional status, the weight levels at 1 year after surgery was better in the LPG-DTR group than in the LPG-TLR group (P0.05).Conclusion: The anti-reflux effect and quality of life of LPG-DTR for AEG were comparable to those of LPG-TLR. Compared with LPG-TLR, LPG-DTR provide better nutrition status for patients with AEG. LPG-DTR is a superior reconstruction method after proximal gastrectomy.

Background: Traditional open gastric cancer surgery has evolved from porous to reduced-hole, single-hole, or even natural cavity surgery to laparoscopic surgery, due to the continuous development of minimally invasive concepts and medical technologies, as well as awareness for the concept of rapid recovery. Conventional laparoscopic radical gastrectomy is quite mature in age at the moment, but how to progress to minimally invasive surgery without increasing the difficulty of surgery while ensuring clinical safety and feasibility is worth further investigation. Therefore, the clinical safety and feasibility of reduced port laparoscopic radical gastrectomy were assessed in this study.Methods: Information on the clinical data of patients undergoing laparoscopic radical gastric cancer surgery in a single centre between May 2020 and May 2022 was collected, and a total of 232 patients were included in this study according to the study protocol design. The clinical data of 232 patients with gastric cancer treated by two different surgical methods, namely, reduced port laparoscopic surgery (RPLS) or conventional laparoscopic surgery (CLS), were retrospectively analysed. The intraoperative indices, postoperative pathological indices, and short-term postoperative complications (within 30 days) of the two different surgical methods were evaluated, as well as the surgical methods’ feasibility and short-term postoperative recovery effect.Results: There was no significant difference between the general data of patients with RPLS and CLS (P &gt; 0.05). Compared with CLSG, the operation time, digestive tract reconstruction time and lymph node dissection time of RPLSG are shorter. The intraoperative blood loss was less, and the incision was minimally invasive (P &lt; 0.05). In the short-term postoperative effect, the level of white blood cell count on the first day, the time of getting out of bed, the time of removing drainage tube, the time of hospitalization and the VAS of pain on the first, third and fifth days after operation, RPLSG was obviously superior to CLSG (P &lt; 0.05). There was no significant difference between RPLSG and CLSG in terms of pathological indices (P &gt; 0.05).Conclusions: The treatment of gastric cancer with RPLS has good safety, feasibility and short-term postoperative effects, which is in line with the implementation of the modern concept of rapid rehabilitation surgery.

Introduction: The role of prophylactic ileostomy (PI) and its potential to reduce the risk of postoperative complications such as anastomotic leakage remains unclear. Methods: The PILLAR study (2018–2020, China, 17 centers) prospectively compared PI versus nonprophylactic ileostomy (NPI) in patients undergoing laparoscopic low anterior resection for rectal cancer. The primary endpoint was the anastomotic leakage rate. Secondary endpoints included postoperative complications, leakage management/outcomes, and leakage-associated risk factors. Results: A prospective study was conducted to gather data from 728 patients who underwent laparoscopic low anterior resection for rectal cancer, 192 (26.4%) of whom underwent PI. Seven cases of anastomotic leakage were observed in the PI group (3.6%) and 25 cases were observed in the NPI group (4.7%). Statistical analysis revealed no significant difference in the incidence of anastomotic leakage between the two groups. Moreover, the total complication rates were 17.2% in the PI group and 10.3% in the NPI group ( P = 0.012). However, the patients with anastomotic leakage in the NPI group had more severe abdominal infections, as evidenced by the C-reactive protein (CRP) values on postoperative day 5 (184.1 ± 72.2 and 77.2 ± 17.0 mg/L in the NPI and PI groups, respectively) ( P < 0.001). Patients’ postoperative procalcitonin (PCT) values similarly support this conclusion. Notably, despite this difference in infection severity, there was no statistically significant difference in the treatment or outcomes of patients with anastomotic leakage in either group. Furthermore, male sex and CRP levels on the fifth postoperative day are identified as independent risk factors for anastomotic leakage. Conclusions: PI may have failed to decrease the incidence of anastomotic leakage in patients who underwent laparoscopic low anterior resection for rectal cancer. Given the higher complication rate associated with PI, its use as a preventive measure for patients at risk of anastomotic leakage should be carefully considered.