Does different surgical approaches affect tolerance to postoperative adjuvant chemotherapy in early-stage upper gastric cancer?

[OBJECTIVE] To compare the effects of laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) vs. laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) on tolerance to postoperative adjuvant chemotherapy in early-stage upper gastric cancer, providing evidence for surgical strategy selection and its impact on chemotherapy outcomes.

[METHODS] In this retrospective cohort study, clinical data were collected from 76 patients with early-stage upper gastric cancer who underwent postoperative chemotherapy following either LPG-DTR or LTG-RY at our institution between January 2020 and January 2023. Patients were stratified into the DTR group ( = 35) and RY group ( = 41) based on surgical approach and digestive reconstruction.

[RESULTS] Compared with the R-Y group, the DTR group had a longer operation time, and a smaller number of lymph node dissections (all  < 0.05).Chemotherapy completion rates showed no significant intergroup difference (all  > 0.05).The DTR group demonstrated:Lower incidence of grade ≥2 adverse events (per CTCAE v5.0 criteria), Reduced requirement for granulocyte colony-stimulating factor (G-CSF)Increased utilization of antiemetics (e.g., ondansetron, azasetron) (all  < 0.05).

[CONCLUSION] LPG-DTR is associated with attenuated myelosuppression and decreased incidence of specific chemotherapy-related toxicities (thrombocytopenia, hepatotoxicity, peripheral neuropathy). Preservation of partial gastric function may underlie these advantages and potentially improve quality of life during adjuvant treatment.