Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG)

Abstract

Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.

Comparison of Proximal Versus Total Gastrectomy in the Surgical Treatment of Proximal Gastric Cancers

“…Group TG PG tant, because, unfortunately, long-term survival is extremely low in gastric cancer patients. The results of the current study were consistent with the findings in the literature, as the time to oral feeding and reaching the target oral calorie intake was observed to be achieved more quickly with fewer problems in the PG group (8,13,22,23). Moreover, since duodenal transit was preserved, the adverse effects of by-passing the duodenum were not documented.…”

“…The main reason for the number of lymph nodes less than 25 in both groups can be explained by that D1 dissection was applied to seven patients in the TG group and to five patients in the PG group because the intraoperative determination of small peritoneal metastases could not be detected preoperatively with imaging methods. In the literature, many studies have demonstrated that although fewer lymph nodes have been harvested in the PG than the TG, no statistically significant difference was found between the two surgical procedures regarding survival rates; the extent of resection has not affected the outcome once adequate resection margins have been reached (7,9,16,17). The results of these studies were harmonious with our manuscript.…”

“…Alternatively, others emphasize that PG achieves a survival rate equivalent to that of TG, with the added advantage of preservation of the physiologic function of the gastric remnant. There are many reports in the literature demonstrating that the oncological results of PG concerning lymphadenectomy, oral resection margins, morbidity, recurrence and survival, are comparable with the results of TG (8)(9)(10).…”

“…Although there is a well-documented shift from distal to proximal lesions, the optimal treatment for these proximal tumors is still a matter of debate. Although advocates of total gastrectomy (TG) emphasize the potential benefit of more radical lymph node dissection (8), proximal gastric cancers rarely metastasize to the lymphatic stations in the vicinity of the distal stomach, especially to the supra and infrapyloric lymph node stations and the surgical dissection of these stations has a very little contribution to the treatment of the patients (9,14). Additionally, in tumors with cardia localization, the distal lymph node stations, especially station number 6, are not included within the D2 dissection limits.…”

Functional evaluations comparing the double-tract method and the jejunal interposition method following laparoscopic proximal gastrectomy for gastric cancer: an investigation including laparoscopic total gastrectomy

“…At the initial point of this study, the control group had not been determined because of the difference in indications between LPG and L-TG. It became clear that the postoperative QOL was similar between L-DT and L-JIP, and some researchers have reported that there were few significant differences in the postoperative QOL between total and proximal gastrectomy [14, 15]. …”