ASO Author Reflections: Robotic Proximal Gastrectomy with Double-Tract Reconstruction and En-Bloc Distal Pancreatectomy: Balancing Oncologic Efficacy and Functional Preservation in Locally Advanced Gastroesophageal Junction Tumors.

Tumor resection is a commonly used treatment method in clinical practice. With the increasing refinement of tumor surgery, the application of robotic-assisted surgery in clinical procedures has expanded. However, effective indicators for evaluating surgical efficacy and postoperative prognosis remain limited. This study introduced the systemic immune-inflammatory index (SII) to evaluate perioperative inflammatory responses and postoperative recovery following robotic and conventional laparoscopic surgery. A total of 81 patients who underwent robotic-assisted gastrointestinal tumor resection and 81 patients who underwent conventional laparoscopic gastrointestinal tumor resection were included. SII was calculated using the formula: platelet count × (neutrophil count/lymphocyte count). Postoperative SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) increased after surgery, peaked on postoperative day 3, and gradually returned toward baseline by postoperative day 7. From postoperative day 3 onward, SII and NLR values in the robotic surgery group were significantly lower than those in the laparoscopic surgery group (P < 0.05), and these differences remained significant on postoperative days 5 and 7 (P < 0.05). PLR values were significantly lower in the robotic surgery group on postoperative day 3 only (P < 0.05), whereas no significant differences were observed on postoperative days 5 or 7 (P > 0.05). Patients in the robotic surgery group also demonstrated improved postoperative recovery indicators, including earlier ambulation, earlier postoperative exhaust and feeding, lower average drainage volume and shorter postoperative hospital stay. These findings suggest that SII may serve as a useful indicator for evaluating postoperative inflammatory status and perioperative recovery following minimally invasive gastric cancer surgery.

The optimal surgical approach for upper gastric cancer remains controversial, particularly regarding the postoperative quality of life (QOL) and nutritional outcomes. This study compared the outcomes of subtotal gastrectomy (STG), proximal gastrectomy (PG), and distal gastrectomy (DG). We retrospectively analyzed 94 patients who underwent gastrectomy for upper gastric cancer (DG: n = 39, PG: n = 33, STG: n = 22). The quality of life (QOL) was assessed using the Postgastrectomy Syndrome Assessment Scale (PGSAS-45) 12 months postoperatively. The nutritional status was evaluated based on changes in body weight. The baseline clinicopathological factors and TNM stages were comparable among the three cohorts. PG was associated with significantly worse reflux, dyspepsia, and meal-related complaints than STG and DG. The STG showed fewer dumping-related symptoms than the PG. No significant differences in overall nutritional status were observed between the STG and DG groups, whereas the PG group tended to be associated with less favorable nutritional outcomes. These findings were consistent with the responder analyses. In this retrospective cohort study, STG was associated with a more favorable postoperative symptom profile than PG and showed postoperative outcomes comparable to those of DG.

In minimally invasive surgery for upper gastric and esophagogastric junction cancers, linear staplers are commonly used, and reports of circular‑stapled reconstruction have declined in parallel with the decrease in open surgery. Lower mediastinal reconstruction during robot‑assisted gastrectomy also remains technically challenging. This study describes our surgical technique and preliminary experience with transhiatal lower mediastinal anastomosis using a circular stapler. Twelve patients who underwent robot‑assisted total or proximal gastrectomy with lower mediastinal reconstruction between March 2023 and December 2025 were included. Total operative time, blood loss, reconstruction time, length of hospital stay, postoperative complications, and esophageal transection length were evaluated separately for robot‑assisted total gastrectomy (RTG) and robot‑assisted proximal gastrectomy (RPG). No patient required conversion to open surgery.In the RTG group (n=6), the operative time, reconstruction time, blood loss, and hospital stay were 498.0 ± 61.1 minutes, 36.2 ± 8.4 minutes, 175 ± 117.3g, and 14.3 ± 2.7 days, respectively.In the RPG group (n=6), these values were 345.8 ± 51.5 minutes, 75.6 ± 14.0 minutes, 75.0 ± 98.7g, and 14.3 ± 2.7 days.Postoperative complications included one anastomotic stricture and one Grade B pancreatic fistula, both in the RPG group. No anastomotic leakage occurred in either group. The esophageal transection length was 35.2 ± 14.0mm in the RTG group and 25.5 ± 7.9mm in the RPG group, and all resection margins were negative. Circular staplers are feasible and safe for lower mediastinal reconstruction in robot‑assisted total and proximal gastrectomy.

Proximal gastrectomy (PG) is a curative surgical option that can also improve quality of life. Although esophagogastric anastomosis is a simple one-site procedure, reflux esophagitis remains a concern. This study presents an esophagogastric anastomosis technique that simplifies intra-abdominal manipulation by forming a trapezoidal tunnel in the residual stomach through extra-abdominal manipulation. We then evaluated the feasibility and functional outcomes of this technique. We retrospectively analyzed clinical data from 12 consecutive patients who underwent laparoscopic PG using the trapezoidal tunnel technique between November 2017 and September 2020 at Nippon Medical School Chiba Hokuso Hospital and between October 2020 and May 2022 at Nippon Medical School Hospital. Demographic and clinical pathological characteristics, preoperative details, and postoperative outcomes were analyzed. Reflux and stenosis status was assessed via endoscopy during follow-up conducted at least 1 year after surgery. Laparoscopic PG using the trapezoidal tunnel technique was successfully performed in all 12 cases. The mean operative time was 262 (195-362) minutes (including 57 [40-89] minutes for reconstruction). No postoperative complications of Clavien-Dindo grade II or higher were observed. The mean hospital stay was 12 (10-21) days. Endoscopic findings during postoperative follow-up (61 [14-89 months]) were normal, except for one patient who developed Los Angeles classification grade A esophagitis. Notably, no anastomotic strictures were identified. The trapezoidal tunnel technique is a feasible approach for anti-reflux reconstruction following laparoscopic PG that simplifies intra-abdominal surgical techniques while maintaining favorable postoperative clinical outcomes. Given the retrospective nature of the cases analyzed, further large-scale clinical trials are essential to verify the safety and efficacy of this technique.

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare epithelial malignancies characterized by the coexistence of neuroendocrine and non-neuroendocrine components, each accounting for at least 30% of the tumor. Gastric MiNENs with squamous differentiation are extremely rare. Herein, we report a rare case of gastric MiNEN with focal squamous differentiation, highlighting its aggressive clinical course, early peritoneal dissemination within three months after curative resection, and pathological heterogeneity. An 89-year-old man presented with melena and dysphagia. Computed tomography and upper gastrointestinal endoscopy revealed an advanced tumor in the gastric cardia, and biopsy revealed poorly differentiated adenocarcinoma. The patient underwent laparoscopic proximal gastrectomy with lymphadenectomy. Histopathological examination revealed that the tumor was composed of a high-grade neuroendocrine carcinoma and an adenocarcinoma, including poorly differentiated and signet-ring cell carcinoma components. The Ki-67 labeling index exceeded 90% in hotspot areas. Focal squamous differentiation, suggested by p40 positivity, accounted for approximately 5% of the tumor. Despite curative-intent surgery, the patient showed early postoperative recurrence with malignant ascites and peritoneal dissemination within approximately three months after surgery. Systemic chemotherapy was not administered due to the patient's advanced age and limited performance status. Therefore, the best supportive care was provided. This case highlights the heterogeneity of the components and metastatic patterns of gastric MiNENs with focal squamous differentiation. The clinical features of this case suggest that both high-grade neuroendocrine carcinoma and biologically aggressive adenocarcinoma may contribute to early recurrence of gastric MiNENs.

ObjectiveProximal gastrectomy (PG) is increasingly preferred over total gastrectomy for upper gastric cancer to preserve gastric function, yet postoperative reflux remains a critical challenge. The purpose of this study was to compare and analyze the clinical effects and quality of life following totally laparoscopic proximal gastrectomy with esophagogastrostomy using the overlap method combined with a gastric remnant “U” shaped fold (EGOUF) vs. conventional laparoscopic-assisted esophagogastrostomy.MethodsA retrospective cohort study was conducted involving 60 patients who underwent laparoscopic proximal gastrectomy between January 2023 and March 2025. According to the digestive tract reconstruction method, patients were divided into two groups: the EGOUF group and the non-EGOUF group, each comprising 30 cases. We evaluated the efficacy of the reconstruction method by observing perioperative outcomes, postoperative complications, and short-term nutritional status over a follow-up period of 3–6 months.ResultsAfter 3 months, the incidence of reflux esophagitis in the EGOUF group was significantly lower than in the non-EGOUF group (6.7% vs. 86.7%, P < 0.001). The quality of life in the EGOUF group was superior, with significantly reduced acid reflux and heartburn symptoms (0% vs. 70.0%, P < 0.001). After 6 months, the EGOUF group demonstrated better nutritional preservation, including a higher total protein index [66.8 (64.7, 68.5) g/L vs. 62.2 ± 3.6 g/L, P < 0.001], higher vitamin B12 levels [566.3 ± 56.0 pg/mL vs. 500.0 (480.0, 532.0) pg/mL, P < 0.001], and less weight loss [3.75% ± 6.45% vs. 7.00% (5.00%, 14.00%), P = 0.003]. Other short-term nutritional indicators showed no significant differences. Furthermore, the EGOUF group experienced less intraoperative blood loss [15.0 [10.0, 20.0] mL vs. 50.0 [27.5, 50.0] mL, P < 0.001] and shorter postoperative hospital stays [9.0 [8.8, 10.3] days vs. 12.0 [10.0, 14.0] days, P = 0.001].ConclusionsThe EGOUF technique offers a superior alternative for digestive tract reconstruction following laparoscopic proximal gastrectomy. Compared to the non-EGOUF group, patients undergoing EGOUF experienced significantly lower rates of reflux esophagitis, reduced intraoperative blood loss, quicker postoperative recovery, and better short-term nutritional status, leading to an improved quality of life.

Esophagojejunostomy (EJ) stricture is a clinically significant complication following proximal and total gastrectomy, yet the underlying factors contributing to its development and its long-term implications remain poorly defined. This study evaluated the incidence, risk factors, and clinical impact of EJ stricture in patients undergoing gastrectomy for gastric adenocarcinoma. A retrospective cohort study was conducted that included all consecutive patients who underwent proximal or total gastrectomy with EJ reconstruction for gastric adenocarcinoma at a tertiary referral center (2014-2024). The primary outcome was stricture incidence, and the independent factors associated with stricture were identified. Secondary outcomes included management patterns, readmissions, complications, and survival. Logistic regression was used to identify factors independently associated with stricture; survival was evaluated using Kaplan-Meier analysis. Among 139 patients, 15 (10.8%) developed EJ stricture; of these, three cases (20%) were later attributed to malignant recurrence. Baseline demographics, comorbidity profiles, operative approach, and tumor characteristics were similar between groups. Stricture patients were significantly more likely to have undergone circular anastomosis, either manual or stapled, compared with linear stapled EJ. Multivariable analysis identified circular EJ as the only factor independently associated with stricture (manual: OR 5.94, p = 0.013; stapled: OR 5.44, p = 0.018). Stricture patients had higher readmission rates at 30 days (53.3% vs. 17.7%, p = 0.004) and at 1 year (86.7% vs. 46.8%, p = 0.004). Median overall survival was significantly reduced among patients with stricture (18.2 vs. 29.3 months, p = 0.046). Malignant recurrence was identified in 20% of stricture cases. EJ stricture occurred in approximately 11% of gastrectomy patients and was strongly associated with circular anastomotic techniques. Stricture formation led to significantly increased readmissions and worse survival, partly due to malignant recurrence presenting as stricture. Linear stapled EJ may reduce the risk of stricture and should be considered when feasible.

Surgical safety and technical optimization of arch-bridge anastomosis after laparoscopy-assisted proximal gastrectomy: An IDEAL stage 2a prospective cohort study.

Gastric signet-ring cell carcinoma (SRCC) is a rare form of gastric cancer characterized by mucus-rich tumor cells forming a distinctive ring-like appearance and is exceedingly rare in children, accounting for less than 1% of all childhood malignancies. We report a case of a 14-year-old patient who presented with melena, hematemesis, and syncope. Upper gastrointestinal endoscopy revealed an ulcerative mass located in the gastric cardia. Histopathological examination confirmed gastric adenocarcinoma demonstrating signet-ring cell features. The patient underwent laparoscopic-assisted radical proximal gastrectomy, esophagogastric anastomosis, abdominal drainage, and a D2 lymphadenectomy, which includes dissection of both perigastric and second-tier lymph nodes. The final diagnosis was SRCC of the stomach. Postoperative Tumor Node Metastasis (TNM) staging was stage III (T3N0M0). Follow-up indicates that the patient remains in good health and has remained symptom-free for 5 years. Given the rarity of this malignancy and the limited number of pediatric case studies, there is an urgent need to accumulate additional clinical and immunohistochemical data to enhance understanding and improve diagnostic accuracy.

Reflux and stenosis after minimally invasive proximal gastrectomy with double-flap technique: risk factors and impact of robotic surgery.

Longitudinal patient-reported outcomes (PROs) can capture symptom burden and functional recovery, but benchmarks across gastrectomy, including the impact of bodyweight loss on quality of life, remain unclear. We prospectively collected PRO data (October 2020-January 2025) from patients undergoing gastrectomy who completed the MD Anderson Symptom Inventory at eight time points, from preoperative through postoperative month (POM) 6. Symptom and interference composite scores were calculated as the mean of the top five symptoms and top three interference items identified at postoperative day (POD) 3. Recovery was defined as achieving mild scores (≤3) on both composites. Logistic regression identified factors associated with recovery at POM 1. Bodyweight changes from preoperative baseline were assessed at POM 1, 3, and 6, and their associations with the "enjoyment-of-life" score were examined using Spearman correlation. We analyzed patients who underwent total (TG, n = 44), distal (DG, n = 44), proximal (PrG, n = 22), and partial gastrectomy (n = 14). Symptom burden was greatest around POD 3 across groups. TG patients showed persistently elevated scores in multiple symptoms even at POM 6. Recovery rates at POM 1, 3, and 6 were 63, 72, and 75% after TG and 79, 90, and 96% after other gastrectomies. In multivariable analysis, open TG was independently associated with failure to recover (odds ratio 0.28 [reference: robotic DG]; p = 0.048), whereas robotic TG was not (odds ratio 0.8; p = 0.742). TG and PrG patients experienced 15% BW loss through POM6; however, the enjoyment-of-life score showed no association with BW. Using PRO-based recovery definition, TG was associated with delayed recovery, and postoperative course varied among gastrectomy types.

The tunnel-like flap technique for esophagogastrostomy in laparoscopic proximal gastrectomy: a comparative study on operative efficiency and early outcomes.

Esophagojejunal anastomotic leakage (EJAL) represents a severe postoperative complication following total or proximal gastrectomy. Treatment strategies include conservative management, endoscopic interventions, and surgery; however, comparative data remain limited. This study aimed to compare clinical outcomes of different strategies to identify the optimal approach based on anastomotic defect size. This retrospective study reviewed 100 patients diagnosed with EJAL between January 2015 and October 2024. Patients were categorized into four groups: conservative management, endoscopic vacuum-assisted closure (E-VAC), other endoscopic treatments, and surgery. The primary outcomes were leakage duration and length of hospital stay after EJAL diagnosis, whereas the secondary outcome was time to C-reactive protein normalization. Subgroup analyses were performed according to defect size. Among the 100 patients, 76 were male and 24 were female, with a mean age of 65.7 years. Conservative treatment was the most common modality (53%), followed by other endoscopic treatments (19%), E-VAC (14%), and surgery (14%). In patients with a defect size <1 cm, conservative treatment was associated with significantly shorter leakage duration (P=0.035) and earlier resumption of diet (P=0.029) compared with endoscopic treatment. Among those with defects ≥2 cm, E-VAC demonstrated the most favorable median outcomes across all variables; however, statistical significance was not achieved because of the small sample size. Conservative treatment appears to be the most effective treatment strategy for EJAL with anastomotic defects <1 cm. For larger defects (≥2 cm), E-VAC may offer clinical benefit, although further studies are needed to confirm its efficacy. These findings highlight the importance of individualized treatment selection based on defect size.

A 44-year-old man presented in December 2019 with a chief complaint of pericardial discomfort. Type 2 lesion at the esophagogastric junction and enlarged periaortic lymph nodes were observed. After neoadjuvant chemotherapy (docetaxel +oxaliplatin + S-1: DOS), he underwent proximal gastrectomy, double tract reconstruction and para-aortic lymph node dissection. The pathological examination showed residual para-aortic lymph node metastases, Ae, T3N1M1 (LYM) CY0P0H0, pStage Ⅳ, HER2 positive. In November 2021, the patient presented with para-aortic lymph node recurrence and was treated with S-1 + oxaliplatin (SOX) + trastuzumab (Tmab) and paclitaxel + ramucirumab, but the lymph nodes were enlarged and trastuzumab deruxtecan (T-DXd) therapy was started. After 4 courses, tumour markers normalised and para-aortic lymph nodes disappeared. After 17 courses, chemotherapy was discontinued after 1 year of complete response (CR). Sixteen months after completing chemotherapy, the patient maintained a CR. T-DXd was approved for the treatment of HER2-positive unresectable advanced or recurrent gastric cancer from the 6th edition of Gastric Cancer Treatment Guidelines. We report a case of long-term CR maintenance after T-DXd therapy for recurrent esophagogastric junction gastric cancer.

Tunnel anastomosis is a novel anastomotic technique for digestive tract reconstruction following proximal gastrectomy. A previous retrospective study by our team demonstrated its favorable antireflux effect; therefore, we hypothesize that tunnel anastomosis is noninferior to double-tract jejunal interposition reconstruction in preventing postoperative reflux esophagitis, and we will conduct this prospective study to further validate this assumption. In this study, we will prospectively compare tunnel anastomosis with the currently more prevalent double-tract jejunal interposition reconstruction technique to further validate its safety and efficacy. This is a multicenter prospective randomized controlled study that will enroll 240 patients who will undergo proximal gastrectomy. The study will be divided into 2 groups: the tunnel anastomosis group and the double-tract jejunal interposition reconstruction group, with 120 patients in each group. Patients will undergo clinical assessments and complete questionnaires preoperatively, as well as at the 3rd, 6th, and 12th months postoperatively. The primary end point is the incidence of reflux esophagitis within 1 year. The secondary end points include perioperative safety, postoperative quality of life, and postoperative nutritional status. Recruitment of patients commenced in March 2022 and is scheduled to conclude in February 2027. The follow-up for all enrolled patients will be completed by February 2028. To our knowledge, this is the first prospective study on this technique, aiming to provide novel insights into the methods of digestive reconstruction following proximal gastrectomy.

Surgery is not only the mainstay of treatment for gastric cancer but also the key to improving postoperative quality of life for patients. Patient-reported symptoms following radical gastrectomy tend to be diverse and descriptive. This study aims to describe patient self-reported outcomes and compare the differences between total gastrectomy (TG), distal gastrectomy (DG), and proximal gastrectomy (PG). This was a retrospective comparative cohort study that included 578 patients. All these patients were diagnosed with gastric cancer and underwent gastrectomy. The included patients were divided into the TG group, DG group, and PG group. All these data were collected and registered prospectively during the patient's postoperative follow-up process. The analyzed data in this study included food intake, weight loss, sleep disorders, and the most common digestive symptoms, at the postoperative first week (1W), the first postoperative month (1M), the third postoperative month (3M), and the sixth postoperative month after discharge (6M). These data were retrospectively compared in these three groups. Propensity score matching (PSM) was used to decrease selection bias. A 0.02 caliper width was used. After PSM, TG, DG, and PG were compared with each other. Compared with DG and TG, food intake recovered more quickly in PG at 1W (P < 0.05). Food intake in most patients recovered to the normal diet at 3M. 46% of patients (263/578) experienced sleep disorders at 1W. No matter if it is TG, DG, or PG, easy to wake was the main complaint of patients with the insomnia symptom. Compared with TG and PG, weight loss was lowest in DG (P < 0.05). Incidence of digestive symptoms was lowest in DG (P < 0.05). In three groups (TG, DG, and PG), abdominal distention was the most reported discomfort. Compared with DG, the incidence of eating obstruction sensation was higher in TG (P = 0.04) and in PG (P = 0.01). Compared with DG and PG, weight loss was maximum, and the incidence of digestive symptoms was highest in TG. The study found that sleep disorders and abdominal distension were the most common complaints after gastrectomy. Some drugs should be given to relieve these symptoms, and further research is needed to improve the quality of life for these patients.

Right-sided overlap with single flap valvuloplasty (ROSF) is an anti-reflux technique first described by our center for direct esophagogastric anastomosis after proximal gastrectomy (PG). This single-center retrospective study aimed to compare the surgical safety, short-term, and medium-term outcomes of ROSF versus double tract reconstruction (DTR) in patients undergoing PG for adenocarcinoma of the esophagogastric junction (AEG). Patients with Siewert type II/III AEG who underwent laparoscopic proximal gastrectomy (LPG) at the Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, from January 2017 to December 2022 were enrolled. Based on the digestive tract reconstruction method, patients were stratified into the ROSF group (n = 43) and DTR group (n = 51). Propensity score matching (PSM) was performed using a 1:1 nearest-neighbor approach with a caliper value of 20% of the propensity score standard deviation, incorporating age, gender, tumor diameter, Siewert classification, clinical T stage, and preoperative L3 skeletal muscle index (L3-SMI) to balance baseline characteristics. A total of 60 patients (30 per group) after propensity score matching (PSM) were included in the final analysis. Postoperative follow-up data (up to 2 years) were analyzed to compare the two groups’ surgical/perioperative parameters, postoperative complications, and serological nutritional indicators. Before PSM, tumor diameter differed significantly between the two groups (P < 0.05); this difference was eliminated after matching (n = 30 per Group, P > 0.05). Compared with the DTR group, ROSF was associated with significantly faster postoperative recovery and better preservation of nutritional parameters and body composition at 1–2 years compared to DTR (all P < 0.05): time to first liquid intake (3.34 ± 1.45 days in ROSF vs. 5.10 ± 2.76 days in DTR), duration of gastric tube retention (0.86 ± 2.49 days in ROSF vs. 4.19 ± 5.15 days in DTR)., time to removal of the posterior anastomotic drain (9.34 ± 3.38 days in ROSF vs. 14.74 ± 12.96 days in DTR), total hospital stay (10.53 ± 4.45 days in ROSF vs. 15.87 ± 13.82 days in DTR), postoperative prealbumin levels at 18 and 24 months, weight loss percentage from 9 months to 2 years postoperatively, body mass index (BMI) from 1 to 2 years postoperatively, and L3 skeletal muscle index (SMI) at 1 year postoperatively. The two groups had no significant differences in postoperative complications or other nutritional indicators (all P > 0.05). For Siewert type II/III AEG meeting surgical indications, ROSF and DTR are feasible reconstruction options after radical PG. ROSF shows promising medium-term (1–2 year) benefits in perioperative recovery and nutritional preservation, and a lower trend of intestinal obstruction, suggesting it is a valuable alternative reconstruction technique for eligible patients.

Optimal reconstruction after laparoscopic proximal gastrectomy (LPG) remains debated. This study compared perioperative outcomes and long-term quality of life (QoL) between tubular esophagogastric (TEG) and double-tract (DT) anastomosis, with attention to age-dependent effects. This retrospective cohort study included 284 patients undergoing LPG with TEG or DT. Exploratory age-stratified analyses were performed. QoL was evaluated using GerdQ, dysphagia scores, and the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45). DT was associated with longer operative time than TEG (232.1 vs 217.6min, P = 0.016), primarily due to prolonged reconstruction time (90.3 vs 66.0min, P < 0.001). In an exploratory analysis of patients aged ≥ 70years, TEG was associated with fewer overall complications than DT (25.9% vs 50.0%, P = 0.049), while complication severity by Clavien-Dindo grade was comparable between groups. This divergence was primarily attributable to non-anastomosis-related complications rather than anastomotic events. In multivariable analysis within the ≥ 70-year subgroup, DT (vs TEG) remained independently associated with postoperative complications (OR 3.57, 95% CI 1.03-12.41; P = 0.045). Conversely, DT demonstrated superior anti-reflux outcomes, including lower GerdQ scores and lower reflux esophagitis rates at 12 and 24months (all P < 0.05). DT also showed lower anastomotic stenosis at 3months (4.0% vs 11.4%, P = 0.038) and better long-term QoL regarding food intake and meal-related distress. DT offers superior reflux control and long-term QoL outcomes. However, in patients aged ≥ 70years, TEG demonstrated a perioperative safety advantage, driven mainly by a lower rate of non-anastomosis-related complications. Reconstruction choice in older patients should be individualized by balancing perioperative risks and long-term functional benefits.

Abstract Proximal gastrectomy (PG) is an important surgical approach for the treatment of adenocarcinoma of the esophagogastric junction (AEG), and the choice of digestive tract reconstruction method has long been a key focus in clinical practice. In 2020, a Chinese expert panel released the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy (2020 Edition)," providing guidance for clinical practice in digestive tract reconstruction after PG. However, as anti-reflux digestive tract reconstruction techniques continue to evolve, various surgical procedures have been innovated, refined, and optimized. To update and promote the latest research findings and perspectives in this field, the Chinese expert panel released the "Chinese expert consensus on digestive tract reconstruction after proximal gastrectomy (2024 Edition)" in 2024. This consensus, based on recent clinical study evidence, provides a comprehensive overview of the definition and indications for PG, the technical essentials and the anti-reflux efficacy of various digestive tract reconstruction procedures. It also proposes the establishment of a scientific evaluation system to assess anti-reflux effects. This review will summarize and interpret the recommendations outlined in the consensus, and simultaneously elaborate on the latest research progress in this field based on this consensus.