# Does different surgical approaches affect tolerance to postoperative adjuvant chemotherapy in early-stage upper gastric cancer?

## TL;DR

This study compares two surgical approaches for early-stage upper gastric cancer and their impact on how well patients tolerate chemotherapy afterward.

## Contribution

The study provides evidence that the choice of surgical approach may influence chemotherapy tolerance and toxicity profiles.

## Key findings

- LPG-DTR was associated with fewer grade ≥2 adverse events compared to LTG-RY.
- Patients in the DTR group required less granulocyte colony-stimulating factor but more antiemetics.
- LPG-DTR showed reduced myelosuppression and specific chemotherapy-related toxicities.

## Abstract

To compare the effects of laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) vs. laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) on tolerance to postoperative adjuvant chemotherapy in early-stage upper gastric cancer, providing evidence for surgical strategy selection and its impact on chemotherapy outcomes.

In this retrospective cohort study, clinical data were collected from 76 patients with early-stage upper gastric cancer who underwent postoperative chemotherapy following either LPG-DTR or LTG-RY at our institution between January 2020 and January 2023. Patients were stratified into the DTR group (n = 35) and RY group (n = 41) based on surgical approach and digestive reconstruction.

Compared with the R-Y group, the DTR group had a longer operation time, and a smaller number of lymph node dissections (all P < 0.05).Chemotherapy completion rates showed no significant intergroup difference (all P > 0.05).The DTR group demonstrated:Lower incidence of grade ≥2 adverse events (per CTCAE v5.0 criteria), Reduced requirement for granulocyte colony-stimulating factor (G-CSF)Increased utilization of antiemetics (e.g., ondansetron, azasetron) (all P < 0.05).

LPG-DTR is associated with attenuated myelosuppression and decreased incidence of specific chemotherapy-related toxicities (thrombocytopenia, hepatotoxicity, peripheral neuropathy). Preservation of partial gastric function may underlie these advantages and potentially improve quality of life during adjuvant treatment.