» Articles » PMID: 18519129

The Difficult Choice Between Total and Proximal Gastrectomy in Proximal Early Gastric Cancer

Overview
Journal Am J Surg
Specialty General Surgery
Date 2008 Jun 4
PMID 18519129
Citations 112
Authors
Affiliations
Soon will be listed here.
Abstract

Background: Surgical results including postoperative complications, prognoses, body weight changes, and nutritional statuses were compared in patients with early gastric cancer in the upper third of the stomach who were treated by total gastrectomy or proximal gastrectomy.

Methods: The authors reviewed clinicopathologic features, postoperative complications, survivals, body weight changes, and biochemical markers after surgery in 423 patients who underwent total or proximal gastrectomy for early gastric cancer in the upper third of the stomach.

Results: The proximal gastrectomy group (n = 89) had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the total gastrectomy group (n = 334). N stages and 5-year survival rates were similar after total and proximal gastrectomy. Postoperative complication rates after total gastrectomy and proximal gastrectomy were 12.6% and 61.8%, respectively, which was significant (P < .001). Rates of anastomotic stenosis and reflux esophagitis were 6.9% and 1.8% after total gastrectomy and 38.2% and 29.2% after proximal gastrectomy, respectively. The parameters that reflect nutritional status (ie, body weight, serum hemoglobin, total protein, albumin, glucose, and cholesterol) were similar in the proximal and total gastrectomy groups at 6, 12, 24, and 36 months postoperatively.

Conclusion: Although the surgical safeties and curabilities of proximal and total gastrectomy were similar, proximal gastrectomy was found to be associated with a markedly higher rate of complications such as anastomotic stenosis and reflux esophagitis and to provide no benefit in terms of postoperative weight loss. The authors conclude that proximal gastrectomy is not a better option for upper-third early gastric cancer than total gastrectomy.

Citing Articles

Can proximal gastrectomy be an alternative to total gastrectomy due to its nutritional advantage? A retrospective cohort study.

Aydogan O, Coskun M, Sekerci U, Carti E Ann Surg Treat Res. 2025; 108(2):79-85.

PMID: 39944921 PMC: 11813547. DOI: 10.4174/astr.2025.108.2.79.


Development and current status of anti-reflux esophagogastrostomy after proximal gastrectomy: a literature review.

Tian Y, Sun K, Shao Q, Nunobe S, Wu Y Langenbecks Arch Surg. 2025; 410(1):41.

PMID: 39820626 PMC: 11739201. DOI: 10.1007/s00423-025-03606-x.


Comparison of proximal gastrectomy with tubular esophagogastric anastomosis and total gastrectomy with Roux-en-Y reconstruction in the treatment of adenocarcinoma of the esophagogastric junction of Siewert type II/III at stage II.

Zhang Z, Zhao T, Wang Y, Xue F, Pu Y, Du Q BMC Surg. 2024; 24(1):382.

PMID: 39614266 PMC: 11607818. DOI: 10.1186/s12893-024-02685-9.


Comparison of short-term clinical efficacy between modified Kamikawa anastomosis and double tract anastomosis after laparoscopic proximal gastrectomy.

Wu C, Huang Q, Ye K Front Oncol. 2024; 14:1414120.

PMID: 39286021 PMC: 11402602. DOI: 10.3389/fonc.2024.1414120.


Novel reconstruction method using long and narrow gastric tube in laparoscopic proximal gastrectomy for cancer: a retrospective case series study.

Ueda Y, Kawasaki T, Tanabe S, Suzuki K, Ninomiya S, Etoh T Front Surg. 2024; 11:1413939.

PMID: 39119245 PMC: 11306146. DOI: 10.3389/fsurg.2024.1413939.