Comparison of Proximal Gastrectomy With Double-Tract Reconstruction and Total Gastrectomy for Stage II-III Upper Gastric Cancer: A Dual-Institutional Propensity Score-Matched Analysis.

PURPOSE: Total gastrectomy (TG) is the standard treatment for stage II-III upper gastric cancer, whereas proximal gastrectomy is primarily used for early-stage disease. This study compared the oncologic and nutritional consequences, including anemia, vitamin B12 deficiency, and body composition changes, between proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG.

MATERIALS AND

METHODS

We retrospectively analyzed a prospectively maintained dual-institutional database of patients who underwent curative-intent PG-DTR or TG for stage II-III gastric cancer between 2015 and 2022. Machine learning-based propensity score matching balanced the clinicopathological variables. Perioperative outcomes, hematologic and nutritional parameters, computed tomography-based body composition, and survival were compared.

RESULTS

After matching, 62 patient pairs were included. Complication rates were comparable between the groups. Five-year cumulative incidences of anemia (86.2% vs. 88.7%, P=0.507), iron replacement (48.7% vs. 58.3%, P=0.595), and vitamin B12 deficiency (8.9% vs. 22.3%, P=0.139) were similar. However, the 5-year cumulative incidence of vitamin B12 replacement was significantly lower after PG-DTR than after TG (46.4% vs. 95.4%, P<0.001). Longitudinal changes in body composition, body weight, hemoglobin level, albumin level, and prognostic nutritional index were similar between the groups. Five-year overall survival rates were 78.9% and 81.1% (P=0.801), and the 5-year recurrence-free survival rates were 73.0% and 78.2% (P=0.690) in the PG-DTR and TG groups, respectively.

CONCLUSIONS

PG-DTR showed no statistically significant differences in perioperative, nutritional, and oncologic outcomes compared with TG in this cohort. These findings should be interpreted cautiously because of the limited statistical power, and larger prospective studies are warranted.