Objective To summarize recent progress of three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer. Methods Recent domestic and international literatures about three types of basic digestive tract reconstruction methods after distal gastrectomy for gastric cancer were collected and analyzed. Results Of the three types of basic digestive tract reconstruction methods, BillrothⅠanastomosis had the most obvious advantage compared to BillrothⅡanastomosis and Roux-en Y anastomosis, but it was limited by tumor' size. The performance of BillrothⅡanastomosis was relatively easier but its complication risk was higher. Roux-en-Y anastomosis was superior in body weight control and treatment of type 2 diabetes mellitus, and had a wider indication than the other two types of methods. The modified uncut Roux-en-Y anastomosis was easier to perform under laparoscopic surgery. Conclusions Each method of the three types of basic digestive tract reconstruction methods after distal gastrectomy has its own superiority and indication. Therefore, the choice of digestive tract reconstruction method after distal gastrectomy should be case by case.
The incidence of esophagogastric junction adenocarcinoma is gradually increasing, and gastrointestinal surgery and thoracic surgery are paying more and more attention to its surgical treatment. “Chinese expert consensus on the surgical treatment of adenocarcinoma of esophagogastric junction (2018 edition)” discussed the core issues in the field of surgical treatment such as definition, classification, surgical approach, lymphadenectomy, digestive tract reconstruction, and neoadjuvant therapy for esophagogastric junction adenocarcinoma, and gave recommendations. However, there is still some controversy about these issues. The author discussed the consensus and controversial issues relevant to esophagogastric junction adenocarcinoma and related research progress in recent years.
Neoadjuvant therapy has become a key component of perioperative management for locally advanced gastric cancer. By inducing tumor downstaging and downgrading, it increases the likelihood of R0 resection, facilitates early control of micrometastatic disease, and informs subsequent adjuvant treatment strategies. However, treatment-induced changes, including tissue edema, adhesions, fibrosis, and disruption of anatomical planes, increase the technical complexity of laparoscopic radical gastrectomy and pose greater challenges to lymph node dissection, margin assessment, gastrointestinal reconstruction, and perioperative management. In the era of neoadjuvant therapy, the goal of gastric cancer surgery has evolved from achieving radical resection alone to balancing oncological efficacy with surgical safety. Standardized laparoscopic techniques, optimized perioperative care, and multidisciplinary management are essential to improve surgical quality and reduce perioperative risks. Future efforts should focus on refining patient selection, optimizing preoperative evaluation and surgical decision-making, and advancing perioperative strategies, thereby promoting a more precise and individualized approach to minimally invasive surgery for gastric cancer.
Advanced Siewert type Ⅱ adenocarcinoma of the esophagogastric junction (AEG) has a unique anatomical location and exhibits heterogeneous biological behavior resembling both esophageal and gastric cancers. It is associated with a high risk of bidirectional lymphatic metastasis to the abdominal cavity and mediastinum, and is often diagnosed at a relatively advanced stage. Therefore, the establishment of precision surgical treatment strategies for this disease remains challenged by several key issues. Based on the latest clinical evidence, guidelines, and expert consensus from China and abroad, and combined with our institutional clinical experience, this article discusses the individualized selection of surgical approaches, precise definition of the extent of lymphadenectomy, safe threshold for the proximal esophageal resection margin, and strategies for digestive tract reconstruction.