Non-Flap Tunnel Technique (NFTT): A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy for Gastric and Esophagogastric Junction Cancer.

[AIM] The incidence of upper-third gastric cancer and esophagogastric junction cancer is increasing, prompting wider adoption of proximal gastrectomy (PG) to preserve postoperative nutritional status and quality of life. Although the double-flap technique (DFT) is effective in preventing reflux after PG, procedural complexity and flap manipulation may contribute to longer reconstruction time and anastomotic stenosis, especially in robotic-assisted procedures. This study aimed to evaluate the non-flap tunnel technique (NFTT) as a simplified alternative to DFT with respect to operative efficiency and anastomotic integrity.

[METHODS] We retrospectively reviewed patients who underwent minimally invasive PG at a single institution between January 2019 and November 2024. Surgical outcomes, including reconstruction time, incidence of anastomotic stenosis, and reflux symptoms, were compared between the DFT and NFTT groups using 2:1 propensity score matching.

[RESULTS] After matching, 62 patients in the DFT group and 31 patients in the NFTT group were included. NFTT was associated with shorter reconstruction time (87 vs. 108 min;  = 0.004) and a lower incidence of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%;  = 0.003). This difference in stenosis rate remained significant in robot-assisted cases (2.5% vs. 30.8%;  = 0.008). No reflux symptoms were observed in the NFTT group, compared to 6.5% in the DFT group ( = 0.30).

[CONCLUSION] NFTT reduced reconstruction time and anastomotic stenosis while maintaining anti-reflux efficacy. These results support NFTT as a technically feasible and effective alternative to DFT for reconstruction following minimally invasive PG. Prospective studies are warranted to validate long-term outcomes.