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

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 proximal gastrectomy and total gastrectomy in the treatment of proximal gastric cancer.

Methods: Between January 2000 and Oct 2022, patients underwent either proximal gastrectomy 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.