Oncological feasibility of laparoscopic subtotal gastrectomy compared with laparoscopic proximal or total gastrectomy for cT1N0M0 gastric cancer in the upper gastric body

Abstract

Background: The upper gastric body is of particular interest in relation to gastrectomy because this area includes a border; that is, both distal and proximal gastrectomy for early gastric cancer can involve this area. Laparoscopic subtotal gastrectomy (LsTG) is reported to be suitable procedure compared with laparoscopic proximal and total gastrectomy (LPG, LTG), regarding postoperative nutritional status and surgical safety. However, whether LsTG is an oncologically acceptable procedure for early gastric cancer in the upper gastric body is unclear.

Methods: We analyzed 215 patients with cT1N0M0 gastric cancer limitedly located in the upper gastric body. The frequency of conversion from each intended procedure to an alternative procedure, the width of the pathological margin, the incidence of lymph node metastasis at each station and the 3-year overall survival (OS) and relapse-free survival (RFS) were evaluated.

Results: LsTG was planned for 65 patients, and LPG for 72 and LTG for 78, respectively. Conversion to other procedures was required in about 10% of patients for whom LsTG or LPG was planned. The width of the pathological margin in patients who underwent LsTG was significantly shorter than patients who underwent the others. No patients who underwent LsTG, LPG or LTG had metastases in station no. 2 or 4sa lymph node. The 3-year OS and RFS rates of patients for whom each procedure was planned were not different.

Conclusions: LsTG could be an oncologically acceptable procedure for cT1N0M0 gastric cancer in the upper gastric body. LsTG could be one option for such disease.

Keywords: Early gastric cancer; Laparoscopic proximal gastrectomy; Laparoscopic subtotal gastrectomy; Laparoscopic total gastrectomy; Upper gastric body.