Safety and short-term oncological outcomes of multimodal modified overlap esophagojejunostomy in total laparoscopic total gastrectomy for elderly patients.

OBJECTIVES: To compare the safety and short-term oncological outcomes of a multimodal modified Overlap esophagojejunostomy versus the conventional Overlap technique in elderly patients undergoing total laparoscopic total gastrectomy (TLTG). METHODS: This retrospective cohort study enrolled elderly gastric cancer (GC) patients who underwent TLTG combined with D2 lymphadenectomy. Patients were divided into two groups based on the digestive tract reconstruction method adopted: the conventional group (n = 154) receiving traditional Overlap esophagojejunostomy and the modified group (n = 103) receiving multimodal modified Overlap esophagojejunostomy. Perioperative and postoperative indicators were compared between the two groups, including total operative time, esophagojejunostomy time, intraoperative blood loss, postoperative complications, postoperative recovery parameters (time to ambulation, first flatus, and liquid diet initiation), length of hospital stay, two-year recurrence rate, as well as postoperative nutritional markers (albumin [ALB], hemoglobin [Hb]) and inflammatory markers (C-reactive protein [CRP], interleukin-6 [IL-6]). RESULTS: The modified group demonstrated significantly shorter total operative time (P = 0.008) and esophagojejunostomy time (P < 0.001). Meanwhile, the modified group achieved faster postoperative recovery, with significantly earlier ambulation (P = 0.008), first flatus (P = 0.036), liquid diet initiation (P = 0.024), and shorter hospital stay (P < 0.001). In terms of postoperative biochemical indexes, the modified group exhibited significantly higher ALB levels (P = 0.006) and lower levels of CRP (P < 0.001) and IL-6 (P < 0.001). No significant differences were observed in postoperative complication rates and two-year recurrence rates between the two groups (P > 0.05). CONCLUSIONS: The multimodal modified Overlap esophagojejunostomy is a safe and efficient surgical technique for elderly patients undergoing TLTG. It can accelerate postoperative recovery, improve early postoperative nutritional status, and alleviate systemic inflammatory responses, without compromising short-term oncological outcomes.