European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Oncological and functional outcomes of proximal versus total gastrectomy for advanced proximal gastric cancer: A propensity score-matched study.
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Yen Hung-Hsuan, Lin Young-Jen, Huang Chun-Chieh, Yeh Chi-Chuan, Lee Po-Chu, Lai I-Rue
Аннотация
BACKGROUND: Proximal gastrectomy (PG) is considered an alternative to total gastrectomy (TG) for proximal gastric cancer (PGC), but its use in advanced stages remains debated. Additionally, data on both oncological and functional outcomes are limited.
METHODS: We conducted a retrospective study on patients with pathological stage II-III PGC undergoing PG with additional distal lymph node sampling or TG with standard D2 lymphadenectomy from 2013 to 2023. Propensity score-matching was applied to adjust for tumor size and stage between these two groups at a 1:1 ratio. We evaluated the procedural safety, oncological, and functional outcomes.
RESULTS: After matching, 48 patients in each group were analyzed, with comparable clinicopathological characteristics. A temporal trend toward increased use of laparoscopic PG was noted. PG was associated with significantly more laparoscopic surgeries, shorter hospital stays and less blood loss compared to TG. Postoperative complication rates were similar between the two groups. Five-year overall (59.0 % for PG vs. 44.2 % for TG; p = 0.494) and recurrence-free (46.5 % for PG vs. 48.2 % for TG; p = 0.981) survival rates were comparable. In multivariate Cox regression analysis, tumor size >7 cm emerged as the only independent risk factor for overall survival, after adjustment for gastrectomy type and other high-risk features, including Borrmann type IV and serosal invasion. Functional outcomes, including weight and hemoglobin changes, showed no significant differences between groups within 24 months postoperatively.
CONCLUSIONS: PG provides comparable oncological outcomes to TG for advanced PGC in carefully selected patients. However, no significant long-term functional benefits were observed.
METHODS: We conducted a retrospective study on patients with pathological stage II-III PGC undergoing PG with additional distal lymph node sampling or TG with standard D2 lymphadenectomy from 2013 to 2023. Propensity score-matching was applied to adjust for tumor size and stage between these two groups at a 1:1 ratio. We evaluated the procedural safety, oncological, and functional outcomes.
RESULTS: After matching, 48 patients in each group were analyzed, with comparable clinicopathological characteristics. A temporal trend toward increased use of laparoscopic PG was noted. PG was associated with significantly more laparoscopic surgeries, shorter hospital stays and less blood loss compared to TG. Postoperative complication rates were similar between the two groups. Five-year overall (59.0 % for PG vs. 44.2 % for TG; p = 0.494) and recurrence-free (46.5 % for PG vs. 48.2 % for TG; p = 0.981) survival rates were comparable. In multivariate Cox regression analysis, tumor size >7 cm emerged as the only independent risk factor for overall survival, after adjustment for gastrectomy type and other high-risk features, including Borrmann type IV and serosal invasion. Functional outcomes, including weight and hemoglobin changes, showed no significant differences between groups within 24 months postoperatively.
CONCLUSIONS: PG provides comparable oncological outcomes to TG for advanced PGC in carefully selected patients. However, no significant long-term functional benefits were observed.