Non-Flap Tunnel Technique (NFTT) - A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy

Sep 28, 2026

Uploaded by acoobca

Upper-third gastric cancer and esophagogastric junction cancer are rising, driving broader use of proximal gastrectomy to preserve postoperative nutrition and quality of life. While the double-flap technique can reduce reflux, its complexity may prolong reconstruction time and increase anastomotic stenosis, especially in minimally invasive and robotic-assisted surgery. This retrospective single-institution study compared non-flap tunnel technique versus double-flap reconstruction for operative efficiency and anastomotic integrity.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

Introduction

Materials and Methods

Annals of Gastroenterological Surgery ORIGINAL ARTICLE OPEN ACCESS Non-Flap Tunnel Technique (NFTT): A Novel Minimally Invasive Reconstruction Method After Proximal Gastrectomy for Gastric and Esophagogastric Junction Cancer Masaru Hayami | Qingjiang Hu | Motonari Ri | Rie Makuuchi | Tomoyuki Irino | Takeshi Sano | Souya Nunobe Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan Correspondence: Souya Nunobe ([souya.nunobe@jfcr.or.jp](souya.nunobe@jfcr.or.jp)) Received: 19 May 2025 | Revised: 9 July 2025 | Accepted: 21 July 2025 Funding: The authors received no specific funding for this work. Keywords: double-flap technique | gastric cancer | minimally invasive surgery | non-flap tunnel technique | proximal gastrectomy 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. | Masaru Hayami and Qingjiang Hu contributed equally to this study. | | --- | | This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2025 The Author(s). Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery. | Annals of Gastroenterological Surgery, 2026; 10:87–94 87 [https://doi.org/10.1002/ags3.70072](https://doi.org/10.1002/ags3.70072) 1 | Introduction The incidence of upper-third gastric cancer and esophagogastric junction (EGJ) cancer has been increasing, necessitating the adoption of function-preserving surgical procedures such as proximal gastrectomy (PG) [1, 2] . In comparison with total gastrectomy, PG has been shown to better preserve postoperative nutritional status and quality of life (QoL) [3] . Nevertheless, the optimal method of reconstruction following PG remains a subject of debate, primarily given the occurrence of complications such as anastomotic stenosis and reflux esophagitis [1, 2, 4] . The double-flap technique (DFT) is widely regarded as an effective anti-reflux reconstruction metho

FAQs

What problem does the non-flap tunnel technique (NFTT) aim to address after proximal gastrectomy?

NFTT is proposed as a simplified alternative to the double-flap technique to improve operative efficiency and maintain anastomotic integrity, addressing complexity-related delays and stenosis risk.

How was the study designed to compare DFT and NFTT?

A retrospective review was conducted for minimally invasive proximal gastrectomy from January 2019 to November 2024, with outcomes compared between groups using 2:1 propensity score matching.

What were the main outcome differences between NFTT and DFT after matching?

NFTT showed shorter reconstruction time (87 vs. 108 minutes) and a lower rate of anastomotic stenosis requiring balloon dilation (3.2% vs. 29.0%). The lower stenosis rate also remained significant in robot-assisted cases.

Sep 28, 2026

Uploaded by acoobca