Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy. However, using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration. In order to overcome these issues and improve patient prognosis, muscle flap reconstruction technique has emerged. Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue. By covering the anastomotic site with muscle tissue, it not only enhances the stability of the anastomosis site but also increases blood supply, promoting healing and recovery of the anastomosis. Therefore, the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied.

To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients’ prognosis.

The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022. All patients underwent esophagogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy. Perioperative indicators were determined, and patients were followed up for 1 year. Furthermore, patient outcomes were observed within 1 year, followed by patient classification based on different outcomes. Moreover, clinicopathological parameters were observed and relevant factors affecting patient prognosis were analyzed.

The operation time was 318 ± 43 min, the formation time of esophageal double muscle flap anastomosis was 110 ± 13 min, the number of lymph node dissections was 26 ± 6, the incision length was 3 ± 0.6 cm, intraoperative bleeding volume was 48 ± 15 mL, first anal exhaust time was 5.3 ± 1.8 d, first meal time was 6.0 ± 1.6 d, length of hospital stay was 11.8 ± 2.5, and treatment cost was 5.8 ± 0.7 thousand yuan. The patient experienced three postoperative complications: 2 cases of pulmonary infection and 1 case of respiratory discomfort. During 1-year follow-up, 50 patients survived and 10 died. Univariate analysis revealed that histological types, tumor size, tumor-node-metastasis staging, vascular invasion, and postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting the prognosis of surviving patients. Furthermore, Cox regression analysis revealed that postoperative adjuvant radiotherapy and chemotherapy were the main factors affecting patient prognosis. The survival time of the survival group was significantly higher than that of the death group (P < 0.05).

Esophagogastric anastomotic using muscle flap reconstruction exhibits good effects on patients who undergo total abdominal gastrectomy for cancer. Postoperative adjuvant radiotherapy and chemotherapy are the main factors affecting patient prognosis.

Gastric cancer is one of the most common tumors of the digestive system worldwide. Although gastric cancer may not have significant manifestations in the early stage, as the disease progresses, systemic symptoms such as emaciation, anemia, and gastric perforation are observed[1]. Surgery is the main treatment strategy for gastric cancer. With recent advances in total laparoscopy, total laparoscopic radical resection has gradually become an important treatment strategy for gastric cancer. Conventional laparoscopic surgery may require at least 5-6 incisions, whereas total laparoscopic surgery requires only 3-4 small incisions, decreasing surgical trauma and postoperative pain[2]. Furthermore, because total laparoscopic surgery is less invasive than conventional laparoscopic surgery, patients can generally return to normal living and working conditions more quickly[3]. Moreover, total laparoscopic surgery does not leave obvious surgical scars; therefore, it is advantageous for patients who pay attention to appearance[4]. Esophagogastrostomy is a method used to repair gastrointestinal anastomosis, called the “double muscle valve”. This technique requires folding the fundus of the stomach, followed by sealing it with two layers of tissue, forming a structure similar to a valve. The application of esophagogastrostomy to total laparoscopic radical resection for gastric cancer can effectively decrease the incidence of complications such as anastomotic incontinence and bile reflux and improve the surgical cure rate and postoperative quality of life, which is a recent topic of interest for surgeons. At present, systematic multivariate analyses of the application effects of esophagogastrostomy in total laparoscopic surgery for gastric cancer and their effects on prognosis remain scarce[5]. In the present study, we conducted surgery and postoperative follow-up of patients with gastric cancer and collected relevant clinical data for esophagogastric anastomosis during postoperative resection for gastric cancer to provide a reference for the clinical improvement of surgical effects, treatment levels, and postoperative rehabilitation efficiency.

Gastric cancer is a malignant tumor occurring in gastric epithelial tissues. The cause of its occurrence has not been thoroughly studied. However, most scholars believe that factors such as curing, smoking, high salt consumption, high-fat consumption, drinking, and eating stale food increase the risk of gastric cancer (history of benign gastric diseases)[6]. Furthermore, chronic atrophic gastritis, gastric polyps, and Helicobacter pylori infection may also increase the probability of gastric cancer occurrence. According to statistics, gastric cancer is one of the most common cancers worldwide; however, its incidence in developed countries has decreased significantly. Conversely, its incidence in Asian countries, such as China, South Korea, and Japan, is still high, which can be attributed to the long-term use of high salt and pickled food[7]. Surgery is a common way to treat gastric cancer. With the development of laparoscopic technology and improvement in medical sciences, the total laparoscopic radical resection of gastric cancer has gradually become the mainstream operation of gastric cancer[8]. Esophagogastric anastomoplasty is a technique in which the esophagus and gastric resection are connected by surgery to restore the gastrointestinal digestive function of patients. Combining it with the total laparoscopic radical resection of gastric cancer can further restore the gastrointestinal function of patients, and such a combination has been applied in treating diseases including esophageal and cardiac cancers[9,10].

The perioperative indicators showed in this study, such as operation time (318 ± 43 min), esophageal anastomosis time (110 ± 13 min), lymph node dissection (26 ± 6), incision length (3.4 ± 0.6 cm), intraoperative bleeding (48 ± 15 mL), anal first discharge time (5.3 ± 1.8 d), first feeding time (6.0 ± 1.6 d), hospitalization time (11.8 ± 2.5), treatment cost (5.8 ± 0.7 thousand yuan), and a poor prognosis ratio of about 16.67%, were consistent with the results of Tian et al[11]. The results of the present study indicate that the double muscle valve plasty of esophagogastric stomosis can indeed be combined with the total laparoscopic radical surgery of gastric cancer to achieve a good curative effect in the near future. Laparoscopic surgery combined with gastric anastomosis double muscle valve plasty can retain the function of the upper stomach and lower esophagus and reduce the effect of surgery on the digestive function of the patient. Furthermore, the double muscle valve structure can avoid gastric content reflux into the esophagus and improve surgical safety. Additionally, autologous tissue repair can avoid the risk of foreign body infection. Simultaneously, as the entire operation was performed using full laparoscopic technology, the operation site was visible, which aided in the accuracy of the operation so as to better protect the nerve and vascular tissues, avoid surgical injury, and improve the efficiency of postoperative rehabilitation to some extent. To summarize, considering patient efficacy, total laparoscopic gastric cancer radical resection with esophagogastric stomosis exhibits remarkable advantages such as high surgical accuracy, high resection rate, low postoperative pain, quick recovery, and digestive function retention.

Statistical data show that the one-year survival rate of patients with gastric cancer treated with radical surgery is about 70%-90%[12]. In the present study, after the one-year follow-up of the 60 patients, their one-year survival rate was 83.33%, consistent with the epidemiological statistics. The univariate analysis showed differences in histological type, tumor size, TNM stage, vascular invasion, and postoperative adjuvant chemoradiation between the surviving and dying patients. This is similar to the conclusion of the Tougeron et al[13]. The histological types of gastric cancer usually include adenocarcinoma, papillary adenocarcinoma, and mucinous adenocarcinoma, and some differences occur in the prognosis of these different histological types. A study has shown that patients with mucinous adenocarcinoma usually exhibit a higher survival rate compared with patients with the other types[13]. Tumor size is another important factor affecting the prognosis of patients with gastric cancer. Generally, the smaller the tumor, the better the prognosis. Clinically, the tumor size is usually graded according to the diameter, and patients with tumors of 5 cm or less usually exhibit a high survival rate[14]. TNM stage is an important indicator to examine the prognosis of patients with gastric cancer, which can be divided into four stages: Stage I (localized gastric cancer), stage II (locally spread gastric cancer), stage III (lymph node metastasis gastric cancer), and stage IV (distant organ metastasis gastric cancer). Most studies have shown that the higher the grade of the stage, the lower the survival proportion[15]. Vascular invasion is another important indicator associated with the survival rate of patients with gastric cancer, and its survival proportion is usually lower for patients whose tumor has invaded lymphatic or blood vessels[16]. This suggests a possible connection between the histological type, tumor size, TNM stage, vascular invasion, postoperative adjuvant chemoradiotherapy, and prognosis of patients with gastric cancer undergoing esophagogastric anastomosis valvuloplasty combined with total laparoscopic gastrectomy. The Cox regression analysis showed that postoperative adjuvant chemoradiotherapy was the main factor affecting the prognosis of patients, and patients who did not receive postoperative adjuvant chemoradiotherapy had a higher risk of a poor prognosis. The reason may be that postoperative adjuvant chemoradiotherapy removes the residual cancer cells after surgery and reduces the risk of tumor recurrence and metastasis by eliminating the small metastatic focus, thus improving the survival rate of patients[17-19].

In conclusion, esophagogastric-stapled muscle valvuloplasty showed good results in total abdominal gastric cancer. Postoperative adjuvant chemoradiotherapy was the main factor affecting the prognosis of patients. However, the study has the following limitations: The small number of samples, the single source, and the lack of analysis of the long-term efficacy of patients. Thus, large-sample, multi-center, and long-term studies are needed in the future to confirm the present results.

I would like to express my sincere thanks to all those who participated in the manuscript.