Clinical value of totally laparoscopic proximal gastrectomy with preservation of hepatic and celiac branches of the vagus nerve for early upper gastric cancer

Objective To investigate the clinical value of totally laparoscopic proximal gastrectomy with preservation of hepatic and celiac branches of the vagus nerve for early upper gastric cancer.

Methods The retrospective and descriptive study was conducted. The clinicopatho-logical data of 12 patients with early upper gastric cancer who were admitted to Fujian Cancer Hospital from January 2024 to February 2025 were collected. There were 10 males and 2 females, aged 69(61,73)years. All patients underwent 3D laparoscopic proximal gastrectomy, with standard lymphadenectomy while preserving hepatic and celiac branches of the vagus nerve. Observation indicators: (1) surgical situations; (2) postoperative pathological situations; (3) postoperative com-plications; (4) follow-up. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(Q₁,Q₃). Count data were described as absolute numbers.

Results (1) Surgical situations. All patients underwent totally laparoscopic proximal gastrectomy with preservation of hepatic and celiac branches of the vagus nerve and double-tract digestive tract reconstruction, without conversion to open surgery. The operation time of 12 patients was (269±68)minutes, volume of intraoperative blood loss was 50(20,50)mL, length of incision was (4.5±0.5)cm, time to postoperative first nasogastric intake of liquid food was 2.0(1.0,3.0)days, time to postoperative first oral intake of liquid food was 6.0(5.0,8.0)days, duration of postoperative hospital stay was 11.0(9.0,13.5)days. (2) Postoperative pathological situa-tions. The distance of upper resection margin of 12 patients was (3.7±2.0)cm, distance of lower resection margin was (3.5±0.9)cm, the total number of lymph node dissected was 27(21,37), the number of positive lymph node was 0. All patients achieved R₀ resection with negative margins. For pathological T stage, there were 3 cases as T1a stage, 8 cases as T1b stage, and 1 case of T2 stage. (3) Postoperative complications. Of the 12 patients, 2 cases developed postoperative complications, and were improved after symptomatic treatment. No patient died during the perioperative period. No anastomotic leak, anastomotic bleeding, intra-abdominal infection, chyle leak, pancreatic fistula, or bowel obstruction occurred. (4) Follow-up. All 12 patients were followed for 13.5(5.5,17.0)months. Results of iodine angiography at postoperative 3 month showed a proportion of contrast media entering the remnant stomach as 50.8%±20.7%. The overall postoperative health status score of the EORTC-QLQ-C30 Quality of Life Questionaire at postoperative 3 month for patients was 79.2(75.0,83.3). No tumor local recurrence or distant metastasis occurred. No reflux-related symptoms such as heartburn or vomiting was observed during follow-up.

Conclusion Totally laparoscopic proximal gastrectomy with preser-vation of hepatic and celiac branches of the vagus nerve is safe and feasible for early upper gastric cancer.