This two-center retrospective observational cohort study compares Chinese and Russian patients who underwent curative proximal gastrectomy with double-tract reconstruction for proximal gastric adenocarcinoma or Siewert type II/III adenocarcinoma of the esophagogastric junction. The study evaluates postoperative reflux, nutritional status, perioperative outcomes, complications, and long-term survival. Propensity score matching will be used to improve comparability between the two cohorts.
Age 18 to 75 years.
Histologically confirmed gastric adenocarcinoma or Siewert type II/III adenocarcinoma of the esophagogastric junction.
Underwent proximal gastrectomy with double-tract reconstruction.
Surgery performed with curative intent.
Previous gastric or esophageal surgery, except limited endoscopic treatment such as endoscopic mucosal resection.
Synchronous or metachronous malignancy, except cured non-melanoma skin cancer or cervical carcinoma in situ.
Complete absence of follow-up data.
Double-tract reconstruction not completed or changed to another reconstruction method.
Patients treated from June 2015 through June 2025 at either participating center who underwent curative proximal gastrectomy with double-tract reconstruction for proximal gastric adenocarcinoma or Siewert type II/III adenocarcinoma of the esophagogastric junction.
Cohort
Retrospective
Proximal gastrectomy with double-tract reconstruction
Procedure/SurgeryCurative proximal gastrectomy followed by double-tract reconstruction performed as part of routine clinical care. The study does not assign treatment and retrospectively analyzes existing clinical data.
Endoscopic reflux esophagitis
Presence and severity of reflux esophagitis assessed by endoscopy using the Los Angeles classification (grades A-D).
Clinically significant reflux symptoms
Reflux symptoms assessed using the GERD-Q questionnaire; a total score greater than 8 is considered clinically significant reflux.
Change in body mass index
Change in body mass index, measured in kilograms per square meter.
Change in serum albumin
Change in serum albumin concentration, measured in grams per liter.
Perioperative outcomes-Operative time
Operative time in minutes
Postoperative complications
Overall complications, severe complications defined as Clavien-Dindo grade IIIa or higher, anastomotic leakage, and anastomotic stricture requiring endoscopic dilation or another intervention.
Overall survival
Time from surgery to death from any cause. Participants alive at last follow-up will be censored.
Disease-free survival
Time from surgery to first local, regional, or distant recurrence or death from any cause. Event-free participants will be censored at last follow-up.
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The First Affiliated Hospital with Nanjing Medical University
Lead sponsor
Moscow Clinical Scientific Center named after A.S. Loginov
Collaborator
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