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Comparative Study
. 2025 Oct 1;88(10):800-806.
doi: 10.1097/JCMA.0000000000001287. Epub 2025 Sep 3.

Comparison of operative outcomes between proximal and total gastrectomy for proximal gastric cancer

Chin-Yung Chen  1   2 , Ching-Yun Kung  1   2 , Bor-Shiuan Shyr  1   2 , Kuo-Hung Huang  1   2 , Wen-Liang Fang  1   2 , Shih-Chieh Lin  2   3 , Anna Fen-Yau Li  2   4 , Su-Shun Lo  2   5 , Chew-Wun Wu  1   2 , Yuan-Tzu Lan  2   6
Affiliations
Comparative Study

Comparison of operative outcomes between proximal and total gastrectomy for proximal gastric cancer

Chin-Yung Chen et al. J Chin Med Assoc. .

Abstract

Background: Total gastrectomy and proximal gastrectomy (PG) are both treatment options for proximal gastric cancer. Currently, there is no consensus on which procedure is better. The aim of this study was to compare the operative outcomes between PG and total gastrectomy in the treatment of proximal gastric cancer.

Methods: Between January 2000 and October 2022, patients who underwent either PG with double tract reconstruction (PG-DTR) or total gastrectomy with Roux-en-Y reconstruction (TG-RY) for proximal gastric cancer were included. The clinicopathologic characteristics and operative outcomes were compared between the two groups. Propensity score matching was performed to compare the short- and long-term outcomes between the two groups.

Results: A total of 263 patients were included in the study. After propensity-score matching, there was no significant difference in clinicopathological characteristics between the two groups. The TG-RY group had more retrieved lymph nodes (37.8 ± 18.6 vs 28.7 ± 15.4; p = 0.022) and a longer hospital stay (13.6 ± 10.2 vs 9.4 ± 3.3 days; p = 0.036) than the PG-DTR group. Surgical complications were similar between the two groups. The PG-DTR group had a greater prevalence of reflux esophagitis (21.4% vs 7.1%; p = 0.034), a higher postoperative/preoperative body weight ratio (0.91 ± 0.08 vs 0.84 ± 0.14; p = 0.021), and a higher postoperative/preoperative serum albumin ratio (1.07 ± 0.11 vs 0.96 ± 0.18; p = 0.004) than the TG-RY group.

Conclusion: Compared with TG-RY, PG-DTR was associated with better postoperative nutritional status and comparable operative complications.

Keywords: Double tract reconstruction; Operative outcome; Proximal gastrectomy; Roux-en-Y reconstruction; Total gastrectomy.

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Conflict of interest statement

Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

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