Clinical Outcomes of Gastric Cancer Patients Who Underwent Proximal or Total Gastrectomy: A Propensity Score-Matched Analysis

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2017 Oct 24

PMID 29058068

Citations 25

Authors

Yuki Ushimaru

Yoshiyuki Fujiwara

Yuji Shishido

Yoshitomo Yanagimoto

Jeong-Ho Moon

Keijiro Sugimura

Takeshi Omori

Hiroshi Miyata

Masahiko Yano

Affiliations

Soon will be listed here.

Abstract

Background: Total gastrectomy (TG) and proximal gastrectomy (PG) are used to treat upper-third early gastric cancer. To date, no consensus has been reached regarding which procedure should be selected. The aim of this study was to validate the usefulness of preserving the stomach in early upper-third gastric cancer.

Methods: Between 2004 and 2013, 201 patients underwent PG or TG at our institution for treatment of upper-third early gastric cancer. According to the defined inclusion and exclusion criteria, 192 cases were enrolled in this study. One-to-one propensity score matching was performed to compare the outcomes between the two groups.

Results: The operation time was shorter in the PG group. Although no significant difference was observed, the PG group had less bleeding and fewer postoperative complications. R0 resection rate was 100%, and no surgery-related deaths were observed. The frequencies of reflux symptoms and anastomotic stenosis were significantly higher in the PG group, but could be controlled by balloon dilation and drug therapy. The maintenance rates of body mass index and lean body mass were significantly higher in patients who underwent PG than TG. The total protein and serum albumin values were higher in the PG group than in the TG group and remained statistically superior.

Conclusion: PG group exhibited better perioperative performance. Furthermore, better nutritional results were obtained in the PG group. Although the late stenosis and reflux symptoms must be addressed, the PG is a preferable surgical procedure for the treatment of early proximal gastric cancer.

Citing Articles

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Study of Short-Term and Long-Term Outcomes Between Esophagogastrostomy and Double-Tract Reconstruction After Proximal Gastrectomy.

Hasegawa T, Kubo N, Sakurai K, Nishimura J, Iseki Y, Nishii T J Gastrointest Cancer. 2024; 55(3):1089-1097.

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Effect of Vitamin B12 Replacement Intervals on Clinical Symptoms and Laboratory Findings in Gastric Cancer Patients after Total Gastrectomy.

Park S, Eom S, Lee H, Eom B, Yoon H, Kim Y Cancers (Basel). 2023; 15(20).

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Outcomes of Proximal Versus Total Gastrectomy for Proximal Gastric Cancer: A Propensity Score-Matched Analysis of a Western Center Experience.

Uprak T, Ergenc M, Akmercan A, Yegen C J Gastrointest Surg. 2023; 27(8):1560-1567.

PMID: 37130980 DOI: 10.1007/s11605-023-05686-w.

Advantages of Function-Preserving Gastrectomy for Older Patients With Upper-Third Early Gastric Cancer: Maintenance of Nutritional Status and Favorable Survival.

Terayama M, Ohashi M, Ida S, Hayami M, Makuuchi R, Kumagai K J Gastric Cancer. 2023; 23(2):303-314.

PMID: 37129154 PMC: 10154138. DOI: 10.5230/jgc.2023.23.e9.

References

Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M . Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2014; 136(5):E359-86. DOI: 10.1002/ijc.29210. View

Wu H, Rusiecki J, Zhu K, Potter J, Devesa S . Stomach carcinoma incidence patterns in the United States by histologic type and anatomic site. Cancer Epidemiol Biomarkers Prev. 2009; 18(7):1945-52. PMC: 2786772. DOI: 10.1158/1055-9965.EPI-09-0250. View

VISICK A . Measured radical gastrectomy; review of 505 operations for peptic ulcer. Lancet. 1948; 1(6502):551-5. View

Dassen A, Lemmens V, van de Poll-Franse L, Creemers G, Brenninkmeijer S, Lips D . Trends in incidence, treatment and survival of gastric adenocarcinoma between 1990 and 2007: a population-based study in the Netherlands. Eur J Cancer. 2010; 46(6):1101-10. DOI: 10.1016/j.ejca.2010.02.013. View

Steevens J, Botterweck A, Dirx M, van den Brandt P, Schouten L . Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol. 2009; 22(6):669-78. DOI: 10.1097/MEG.0b013e32832ca091. View

Shiraishi N, Adachi Y, Kitano S, Kakisako K, Inomata M, Yasuda K . Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg. 2002; 26(9):1150-4. DOI: 10.1007/s00268-002-6369-6. View

Aoyama T, Kawabe T, Fujikawa H, Hayashi T, Yamada T, Tsuchida K . Loss of Lean Body Mass as an Independent Risk Factor for Continuation of S-1 Adjuvant Chemotherapy for Gastric Cancer. Ann Surg Oncol. 2014; 22(8):2560-6. DOI: 10.1245/s10434-014-4296-z. View

. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14(2):113-23. DOI: 10.1007/s10120-011-0042-4. View

Lee H, Park W, Lee H, Lee K, Park J, Shin S . Endoscopy-guided balloon dilation of benign anastomotic strictures after radical gastrectomy for gastric cancer. Gut Liver. 2014; 8(4):394-9. PMC: 4113056. DOI: 10.5009/gnl.2014.8.4.394. View

10.

Ooki A, Yamashita K, Kikuchi S, Sakuramoto S, Katada N, Hutawatari N . Clinical significance of total gastrectomy for proximal gastric cancer. Anticancer Res. 2008; 28(5B):2875-83. View

11.

Deurenberg P, Weststrate J, Seidell J . Body mass index as a measure of body fatness: age- and sex-specific prediction formulas. Br J Nutr. 1991; 65(2):105-14. DOI: 10.1079/bjn19910073. View

12.

Akarsu C, Unsal M, Dural A, Kones O, Kocatas A, Karabulut M . Endoscopic balloon dilatation as an effective treatment for lower and upper benign gastrointestinal system anastomotic stenosis. Surg Laparosc Endosc Percutan Tech. 2014; 25(2):138-42. DOI: 10.1097/SLE.0000000000000090. View

13.

Shang J, Pena A . Multidisciplinary approach to understand the pathogenesis of gastric cancer. World J Gastroenterol. 2005; 11(27):4131-9. PMC: 4615432. DOI: 10.3748/wjg.v11.i27.4131. View

14.

Hsu C, Chen C, Hsieh Y, Hsia J, Shai S, Kao C . Esophageal reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia. Am J Gastroenterol. 1997; 92(8):1347-50. View

15.

Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T . Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg. 2010; 97(4):558-62. DOI: 10.1002/bjs.6944. View

16.

Huh Y, Lee H, Oh S, Lee K, Yang J, Ahn H . Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis. J Gastric Cancer. 2015; 15(3):191-200. PMC: 4604334. DOI: 10.5230/jgc.2015.15.3.191. View

17.

Yamashita H, Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T . Optimal extent of lymph node dissection for Siewert type II esophagogastric junction carcinoma. Ann Surg. 2011; 254(2):274-80. DOI: 10.1097/SLA.0b013e3182263911. View

18.

Armstrong D, Bennett J, Blum A, Dent J, de Dombal F, Galmiche J . The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology. 1996; 111(1):85-92. DOI: 10.1053/gast.1996.v111.pm8698230. View

19.

. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14(2):101-12. DOI: 10.1007/s10120-011-0041-5. View

20.

Crew K, Neugut A . Epidemiology of gastric cancer. World J Gastroenterol. 2006; 12(3):354-62. PMC: 4066052. DOI: 10.3748/wjg.v12.i3.354. View