{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:13:04Z","timestamp":1785219184396,"version":"3.55.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T00:00:00Z","timestamp":1614124800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["19H03735"],"award-info":[{"award-number":["19H03735"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["19H03735"],"award-info":[{"award-number":["19H03735"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["19H03735"],"award-info":[{"award-number":["19H03735"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["19H03735"],"award-info":[{"award-number":["19H03735"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The optimal reconstruction method after proximal gastrectomy (PG) has been debatable. Recent reports have shown that the double-flap technique (DFT) provides good outcomes in terms of postoperative nutritional status and quality of life. However, no study has compared the clinical outcomes of the DFT with other reconstruction methods. Here, we evaluated and compared the clinical outcomes between the DFT and jejunal interposition (JI) after PG for gastric cancer.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>The medical records of 34 consecutive patients who had undergone PG for upper third gastric cancer between January 2011 and October 2016 were reviewed retrospectively. The main factors investigated were surgical outcomes, postoperative nutritional status, symptoms, and endoscopic findings 1 year after surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Thirty-four patients were enrolled (DFT, 14; JI, 20). The operation time was similar between the two techniques (228 and 246 minutes for DFT and JI, respectively, <jats:italic>P<\/jats:italic> = 0.377), as were the rates of anastomotic complications (7% and 0% for DFT and JI, respectively, <jats:italic>P<\/jats:italic> = 0.412). Body weight loss was significantly lower in the DFT group than in the JI group (-8.1% vs -16.1%, <jats:italic>P<\/jats:italic> = 0.001). Total protein and albumin levels were higher in the DFT group than in the JI group (0% vs -2.9%, <jats:italic>P<\/jats:italic> = 0.053, and -0.3% vs -6.1%, <jats:italic>P<\/jats:italic> = 0.077, respectively). One patient in the DFT group and no patients in the JI group experienced reflux esophagitis (\u2265 grade B) (<jats:italic>P<\/jats:italic> = 0.393). Anastomotic strictures were not observed as postoperative complications in either group.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Surgical outcomes revealed that the DFT was safe and feasible, similar to JI. In terms of controlling postoperative body weight loss, the DFT is a better reconstruction technique than JI after PG.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0247636","type":"journal-article","created":{"date-parts":[[2021,2,24]],"date-time":"2021-02-24T18:37:34Z","timestamp":1614191854000},"page":"e0247636","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["Clinical outcomes of proximal gastrectomy for gastric cancer: A comparison between the double-flap technique and jejunal interposition"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7177-9328","authenticated-orcid":true,"given":"Tsutomu","family":"Kumamoto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Sasako","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinori","family":"Ishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasunori","family":"Kurahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Shinohara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,24]]},"reference":[{"key":"pone.0247636.ref001","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ejca.2015.10.061","article-title":"Survival impact of postoperative body mass index in gastric cancer patients undergoing gastrectomy","volume":"52","author":"HH Lee","year":"2016","journal-title":"Eur J Cancer"},{"key":"pone.0247636.ref002","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.amjsurg.2018.07.003","article-title":"Postoperative development of sarcopenia is a strong predictor of a poor prognosis in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer","volume":"217","author":"K Kudou","year":"2019","journal-title":"Am J Surg"},{"key":"pone.0247636.ref003","article-title":"Japanese gastric cancer treatment guidelines 2018 (5th edition)","author":"Japanese Gastric Cancer Association","year":"2020","journal-title":"Gastric Cancer"},{"key":"pone.0247636.ref004","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1007\/s00423-016-1422-3","article-title":"Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary","volume":"401","author":"P Sugoor","year":"2016","journal-title":"Langenbecks Arch Surg"},{"key":"pone.0247636.ref005","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1007\/s10120-019-00938-8","article-title":"Oncological safety of proximal gastrectomy for T2\/T3 proximal gastric cancer","volume":"22","author":"M Yura","year":"2019","journal-title":"Gastric Cancer"},{"key":"pone.0247636.ref006","first-page":"524","article-title":"Beitr\u00e4ge zur technik der operation des magenkarzinoms (in German)","volume":"57","author":"J Mikulicz","year":"1898","journal-title":"Arc. 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