Non‐Flap Tunnel Technique ( <scp>NFTT</scp> ): A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy for Gastric and Esophagogastric Junction Cancer

Abstract

ABSTRACT Aim The incidence of upper‐third gastric cancer and esophagogastric junction cancer is increasing, prompting wider adoption of proximal gastrectomy (PG) to preserve postoperative nutritional status and quality of life. Although the double‐flap technique (DFT) is effective in preventing reflux after PG, procedural complexity and flap manipulation may contribute to longer reconstruction time and anastomotic stenosis, especially in robotic‐assisted procedures. This study aimed to evaluate the non‐flap tunnel technique (NFTT) as a simplified alternative to DFT with respect to operative efficiency and anastomotic integrity. Methods We retrospectively reviewed patients who underwent minimally invasive PG at a single institution between January 2019 and November 2024. Surgical outcomes, including reconstruction time, incidence of anastomotic stenosis, and reflux symptoms, were compared between the DFT and NFTT groups using 2:1 propensity score matching. Results After matching, 62 patients in the DFT group and 31 patients in the NFTT group were included. NFTT was associated with shorter reconstruction time (87 vs. 108 min; p = 0.004) and a lower incidence of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%; p = 0.003). This difference in stenosis rate remained significant in robot‐assisted cases (2.5% vs. 30.8%; p = 0.008). No reflux symptoms were observed in the NFTT group, compared to 6.5% in the DFT group ( p = 0.30). Conclusion NFTT reduced reconstruction time and anastomotic stenosis while maintaining anti‐reflux efficacy. These results support NFTT as a technically feasible and effective alternative to DFT for reconstruction following minimally invasive PG. Prospective studies are warranted to validate long‐term outcomes.