Functional Outcomes and Anti-Reflux Performance of Reconstruction Methods Following Proximal Gastrectomy: A Systematic Review

Proximal gastrectomy preserves gastric function; however, reconstruction choice influences reflux control and quality of life (QOL), and the comparative efficacy of available techniques remains unclear. A PRISMA-guided search of PubMed and Web of Science Core Collection (January 2000–April 2025) identified studies reporting reflux or QOL outcomes after proximal gastrectomy. Eligible studies included adult gastric cancer cohorts with original clinical data. Two reviewers independently screened articles, extracted predefined variables, and performed a narrative synthesis. The protocol was archived on the OSF. Thirty-two studies (2958 patients) met inclusion criteria. Simple esophagogastrostomy (EG) consistently demonstrated the poorest reflux control and widest range of stricture rates. Double-tract reconstruction (DTR) showed a generally favorable balance among reflux control, low leakage rates, and acceptable stricture rates, suggesting that it may represent a practical and broadly applicable reconstruction option. Jejunal interposition and pouch variants were reported in small, heterogeneous series, limiting their generalizability. Among valve-forming methods, the double-flap technique was associated with very low rates of endoscopic reflux in two Los Angeles–graded cohorts, though a 4–6% stricture rate remained a concern. Evidence for the side overlap with fundoplication by Yamashita, both original and modified, was sparse and inconsistent. Global QOL, assessed using PGSAS-45/37 and EORTC instruments, did not differ consistently between reconstruction types, although specific domains—such as appetite loss, nausea, and weight maintenance—varied sporadically. Available evidence suggests that DTR may be considered a practical and broadly applicable reconstruction option following proximal gastrectomy, whereas the double-flap technique appears to provide strong reflux control but may be associated with a risk of anastomotic stricture. Simple EG may was associated with higher reflux rates across studies and may be less favorable for reflux control. Larger multicenter studies using standardized, nutrition-sensitive QOL measures and physiological reflux testing are needed to optimize reconstruction choice. However, substantial heterogeneity and the limited quality of the available evidence preclude definitive conclusions regarding the superiority of any single reconstruction method.