Comparison of Perioperative and Long‐term Outcomes of Total and Proximal Gastrectomy for Early Gastric Cancer: A Multi‐institutional Retrospective Study

Masuzawa, Toru; Takiguchi, Shuji; Hirao, Motohiro; Imamura, Hiroshi; Kimura, Yutaka; Fujita, Junya; Miyashiro, Isao; Tamura, Shigeyuki; Hiratsuka, Masahiro; Kobayashi, Kenji; Fujiwara, Yoshiyuki; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s00268-013-2370-5

Cited by 77 publications

(83 citation statements)

References 37 publications

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“…While there is still lack of agreement that PG-JI or PG-DT can replace TG-RY, PG-JI and PG-DT, as function-preserving surgery, do have several advantages over TG-RY [3,[6][7][8][12][13][14][15][16][17]. First, the remnant stomach offers significantly increased food intake volume and better QOL for patients.…”

Section: Discussionmentioning

confidence: 99%

“…PG-JI, with its reduction in postoperative body weight loss compared to TG-RY, contributes to better QOL for patients and thus is well adopted [8]. In addition, the incidence of esophageal reflux was reported significantly lower after PG-JI compared to PG-EG [6,9]. Nevertheless, Tokunaga's questionnaire showed that after PG-JI, the interposed jejunum might prevent the smooth passage of food, leading to the abdominal discomfort after meals [10].…”

mentioning

confidence: 86%

“…(PG-EG) inevitably presents a much higher rate of complications such as reflex esophagitis and anastomotic stenosis when compared to total gastrectomy (TG) with Roux-en-Y reconstruction (RY), despite its advantages such as more food intake volume and better nutrition states of the patients [6,7].…”

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confidence: 99%

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A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

Hong

Wang

et al. 2015

Surg Endosc

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Section: Discussionmentioning

confidence: 99%

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A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

Hong

Wang

et al. 2015

Surg Endosc

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“…Among the 3921 individuals comprising the base population, 204 of 300 patients with T1 upper-third gastric cancer underwent proximal gastrectomy. Although LNs lying along the right gastric and right gastroepiploic vessels are not dissected, survival outcome after proximal gastrectomy performed for early upper-third gastric cancer is known to be comparable with that after total gastrectomy [17,18]. Several reports have demonstrated that the occurrence of metastasis from upper-third gastric cancer to LNs at the no.…”

Section: Discussionmentioning

confidence: 99%

“…Although proximal gastrectomy is generally thought to offer advantages over conventional total gastrectomy in terms of maintenance of food intake volume [21][22][23] and postoperative nutrition status [17], reflux esophagitis or Fig. 3 a, b Mapping of the primary tumors with single-site metastasis to the no.…”

Section: Discussionmentioning

confidence: 99%

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

et al. 2016

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Background Proximal gastrectomy has been introduced for early gastric cancer located in the upper third of the stomach, but expansion of its indication to advanced tumors has not been generally accepted in terms of lesser curvature lymph node dissection. Methods We reviewed the medical records of 385 patients with tumors in the upper third of the stomach, and the incidence of metastasis and the therapeutic index related to the proximal (no. 3a) and distal (no. 3b) lymph nodes of the lesser curvature were analyzed and compared with those of tumors in the middle third (n = 1093) and lower third (n = 922) of the stomach. Results The no. 3a rate of metastasis from advanced tumors in the upper third of the stomach was significantly higher than that from tumors in the middle third or lower third of the stomach. The no. 3b metastasis rate did not show any significant differences between the three locations, but the therapeutic index of no. 3b lymph nodes in the upper third of the stomach (1.7) was far lower than that in the middle third (7.1) or lower third (7.0). Further, the rate of metastasis from tumors with the distal border ending in the upper third of the stomach (2.2 %) was significantly (P \ 0.0001) lower than that from tumors located in the upper third of the stomach but extending to the middle third (19.6 %), as well as from tumors located in middle third (17.1 %) or lower third (19.6 %), with the therapeutic index being only 1.1. The four no.-3b-positive tumors all measured more than 40 mm, and included one T3 tumor and three T4 tumors. Conclusion Proximal gastrectomy with exclusion of no. 3b lymphadenectomy could be indicated for at least T2 tumors measuring less than 40 mm localized in the upper third of the stomach.

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Effect of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction vs Total Gastrectomy on Hemoglobin Level and Vitamin B₁₂ Supplementation in Upper-Third Early Gastric Cancer

et al. 2023

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ImportancePatients undergoing proximal gastrectomy (PG) with double-tract reconstruction (DTR) have been reported to have an incidence of reflux esophagitis that is as low as that observed after total gastrectomy (TG). It is unclear whether PG has an advantage over TG for the treatment of patients with upper early gastric cancer (GC).ObjectiveTo evaluate the effect of laparoscopic PG with DTR (LPG-DTR) vs laparoscopic TG (LTG) on levels of hemoglobin and vitamin B12 supplementation required among patients with clinically early GC in the upper third of the stomach (upper-third early GC).Design, Setting, and ParticipantsThis multicenter open-label superiority randomized clinical trial was conducted at 10 institutions in Korea. A total of 138 patients with upper-third cT1N0M0 GC were enrolled between October 27, 2016, and September 9, 2018. Follow-up ended on December 3, 2020.InterventionsPatients were randomized to undergo either LPG-DTR or LTG.Main Outcomes and MeasuresThe primary co–end points were change in hemoglobin level and cumulative amount of vitamin B12 supplementation at 2 years after LPG-DTR or LTG. The secondary end points included morbidity, postoperative reflux esophagitis, quality of life, overall survival, and disease-free survival. Quality of life outcomes were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) 30-item core questionnaire (C30) and the EORTC QLQ stomach cancer–specific questionnaire at 3 months, 12 months, and 24 months.ResultsAmong 138 patients (mean [SD] age, 60.0 [10.9] years; 87 men [63.0%]; all of Asian race and Korean ethnicity), 68 (mean [SD] age, 56.7 [10.4] years; 39 men [57.4%]) were randomized to receive LPG-DTR and 69 (mean [SD] age, 61.3 [11.3] years; 48 men [69.6%]) were randomized to receive LTG. The mean (SD) changes in hemoglobin levels from baseline to month 24 were −5.6% (7.4%) in the LPG-DTR group and −6.9% (8.3%) in the LTG group, for an estimated difference of −1.3% (95% CI, −4.0% to 1.4%; P = .35). The mean (SD) cumulative amount of vitamin B12 supplementation was 0.4 (1.3) mg in the LPG-DTR group and 2.5 (3.0) mg in the LTG group, for an estimated difference of 2.1 mg (95% CI, 1.3-2.9 mg; P &lt; .001). The late complication rates in the LPG-DTR and LTG groups were 17.6% and 10.1%, respectively (P = .31). The incidence of reflux esophagitis was not different between the LPG-DTR and LTG groups (2.9% vs 2.9%; P = .99). Compared with the LTG group, the LPG-DTR group had better physical functioning scores (85.2 [15.6] vs 79.9 [19.3]; P = .03) and social functioning scores (89.5 [17.9] vs 82.4 [19.4]; P = .03) on the EORTC QLQ-C30. Two-year overall survival (98.5% vs 100%; P = .33) and disease-free survival (98.5% vs 97.1%; P = .54) did not significantly differ between the LPG-DTR vs LTG groups.Conclusions and RelevanceIn this study, patients with upper-third early GC who received LPG-DTR required less vitamin B12 supplementation than those who received LTG, with no increase in complication rates and no difference in overall and disease-free survival rates. There was no difference in change in hemoglobin level between groups. In addition, the LPG-DTR group had better physical and social functioning than the LTG group. These findings suggest that LPG-DTR may be as safe as LTG and may be a function-preserving procedure for the treatment of patients with upper-third early GC.Trial RegistrationClinicalTrials.gov Identifier: NCT02892643

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Comparison of Perioperative and Long‐term Outcomes of Total and Proximal Gastrectomy for Early Gastric Cancer: A Multi‐institutional Retrospective Study

Abstract: Three surgical procedures for U-EGC did not result in differences in weight loss, but PG-EG and PG-JI were better than TG-RY according to some nutritional markers. In U-EGC, where patients are expected to have long survival times, PG-EG and PG-JI should be used rather than TG-RY.

Cited by 77 publications

References 37 publications

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

Effect of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction vs Total Gastrectomy on Hemoglobin Level and Vitamin B₁₂ Supplementation in Upper-Third Early Gastric Cancer

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Comparison of Perioperative and Long‐term Outcomes of Total and Proximal Gastrectomy for Early Gastric Cancer: A Multi‐institutional Retrospective Study

Abstract: Three surgical procedures for U-EGC did not result in differences in weight loss, but PG-EG and PG-JI were better than TG-RY according to some nutritional markers. In U-EGC, where patients are expected to have long survival times, PG-EG and PG-JI should be used rather than TG-RY.

Cited by 77 publications

References 37 publications

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

A novel method of delta-shaped intracorporeal double-tract reconstruction in totally laparoscopic proximal gastrectomy

Proximal gastrectomy with exclusion of no. 3b lesser curvature lymph node dissection could be indicated for patients with advanced upper-third gastric cancer

Effect of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction vs Total Gastrectomy on Hemoglobin Level and Vitamin B12 Supplementation in Upper-Third Early Gastric Cancer

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Effect of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction vs Total Gastrectomy on Hemoglobin Level and Vitamin B₁₂ Supplementation in Upper-Third Early Gastric Cancer