Proximal gastrectomy (PG) is one of function‐preserving gastrectomy (FPG). In this study, we compared the long-term results of proximal gastric cancer (PGC) patients undergoing proximal gastrectomy and total gastrectomy (TG).
Method
Patients diagnosed with PGC and receiving PG or TG between 2004 and 2020 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was applied to minimize confounding factors. Kaplan-Meier analysis and log-rank test were used to compare overall survival (OS) and cancer-specific survival (CSS) between the PG and TG groups. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors affecting OS.
Result
A total of 3916 patients were recruited according to the inclusion and exclusion criteria, with 2614 undergoing PG and 1302 undergoing TG. After 1:1 PSM matching, 912 pairs of data were included for analysis. Before PSM matching, PG group tended to have better OS and CSS outcomes. However, after PSM matching, both surgical approaches showed similar long-term results.
Conclusion
PG for PGC yields comparable long-term outcomes to TG and demonstrates safety in terms of oncologic outcomes.
SungHFerlayJSiegelRLLaversanneMSoerjomataramIJemalABrayF. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209-249. doi:10.3322/caac.21660
2.
RahmanRAsombangAWIbdahJA. Characteristics of gastric cancer in Asia. World J Gastroenterol. 2014;20:4483-4490. doi:10.3748/wjg.v20.i16.4483
3.
FanXQinXZhangYLiZZhouTZhangJYouWLiWPanK. Screening for gastric cancer in China: advances,challenges and visions. Chin J Cancer Res. 2021;33:168-180. doi:10.21147/j.issn.1000-9604.2021.02.05
4.
SunDQYangFLiHCaoMMYanXXHeSYZhangSLXiaCFChenWQ. Regional disparities in trends of global gastric cancer incidence and mortality from 1990 to 2019. Zhonghua Zhong Liu Za Zhi. 2022;44:950-954. doi:10.3760/cma.j.cn112152-20220120-00049
5.
Information Committee of Korean Gastric Cancer Association. Korean gastric cancer association nationwide survey on gastric cancer in 2014. J Gastric Cancer. 2016;16(3):131-140. doi:10.5230/jgc.2016.16.3.131
6.
BuasMFVaughanTL. Epidemiology and risk factors for gastroesophageal junction tumors: understanding the rising incidence of this disease. Semin Radiat Oncol. 2013;23(1):3-9. doi:10.1016/j.semradonc.2012.09.008
7.
HamashimaCSystematic Review Group and Guideline Development Group for Gastric Cancer Screening Guidelines. Update version of the Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol. 2018;48(7):673-683. doi:10.1093/jjco/hyy077
8.
KusanoCGotodaTKhorCJKataiHKatoHTaniguchiHShimodaT. Changing trends in the proportion of adenocarcinoma of the esophagogastric junction in a large tertiary referral center in Japan. J Gastroenterol Hepatol. 2008;23(11):1662-1665. doi:10.1111/j.1440-1746.2008.05572.x
9.
FuJLiYLiuXJiaoXWangYQuHNiuZ. Clinical outcomes of proximal gastrectomy with gastric tubular reconstruction and total gastrectomy for proximal gastric cancer: a matched cohort study. Front Surg. 2022;9:1052643. doi:10.3389/fsurg.2022.1052643
10.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14(2):101-112. doi:10.1007/s10120-011-0041-5
11.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer. 2021;24(1):1-21. doi:10.1007/s10120-020-01042-y
12.
Guideline Committee of the Korean Gastric Cancer Association (KGCA), Development Working Group & Review Panel. Korean practice guideline for gastric cancer 2018: an evidence-based, multi-disciplinary approach. J Gastric Cancer. 2019;19(1):1-48. doi:10.5230/jgc.2019.19.e8
13.
TakiguchiNTakahashiMIkedaMInagawaSUedaSNobuokaTOtaMIwasakiYUchidaNKoderaYNakadaK. Long-term quality-of-life comparison of total gastrectomy and proximal gastrectomy by postgastrectomy syndrome assessment scale (PGSAS-45): a nationwide multi-institutional study. Gastric Cancer. 2015;18(2):407-416. doi:10.1007/s10120-014-0377-8
14.
FujiyaKKawamuraTOmaeKMakuuchiRIrinoTTokunagaMTanizawaYBandoETerashimaM. Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol. 2018;25(4):974-983. doi:10.1245/s10434-018-6342-8
15.
RosaFQueroGFiorilloCBissolatiMCipollariCRauseiSChiariDRuspiLde ManzoniGCostamagnaGDogliettoGBAlfieriS. 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). Gastric Cancer. 2018;21(5):845-852. doi:10.1007/s10120-018-0804-3
16.
IchikawaDKomatsuSKubotaTOkamotoKShiozakiAFujiwaraHOtsujiE. Long-term outcomes of patients who underwent limited proximal gastrectomy. Gastric Cancer. 2014;17(1):141-145. doi:10.1007/s10120-013-0257-7
17.
KinoshitaTGotohdaNKatoYTakahashiSKonishiMKinoshitaT. Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery. Surg Endosc. 2013;27(1):146-153. doi:10.1007/s00464-012-2401-6
18.
KurodaSNishizakiMKikuchiSNomaKTanabeSKagawaSShirakawaYFujiwaraT. Double-flap technique as an antireflux procedure in esophagogastrostomy after proximal gastrectomy. J Am Coll Surg. 2016;223(2):e7-e13. doi:10.1016/j.jamcollsurg.2016.04.041
19.
KataiHMoritaSSakaMTaniguchiHFukagawaT. 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):558-562. doi:10.1002/bjs.6944
20.
HayamiMHikiNNunobeSMineSOhashiMKumagaiKIdaSWatanabeMSanoTYamaguchiT. Clinical outcomes and evaluation of laparoscopic proximal gastrectomy with double-flap technique for early gastric cancer in the upper third of the stomach. Ann Surg Oncol. 2017;24(6):1635-1642. doi:10.1245/s10434-017-5782-x
21.
WeiJYangPHuangQChenZZhangTHeFHuHZhongJLiWWeiFWangQCaoJ. Proximal versus total gastrectomy for proximal gastric cancer: a Surveillance, Epidemiology, and End Results Program database analysis. Future Oncol. 2020;17(10):1185-1195. doi:10.2217/fon-2020-1071
22.
UprakTKErgençMAkmercanAYeğenC. Outcomes of proximal versus total gastrectomy for proximal gastric cancer: a propensity score-matched analysis of a western center experience. J Gastrointest Surg. 2023;27(8):1560-1567. doi:10.1007/s11605-023-05686-w
23.
DollKMRademakerASosaJA. Practical guide to surgical data sets: surveillance, epidemiology, and end results (SEER) database. JAMA Surg. 2018;153(6):588-589. doi:10.1001/jamasurg.2018.0501
24.
ShaoWLuZXuJShiXTanTXingCSongJ. Effects of total pancreatectomy on survival of patients with pancreatic ductal adenocarcinoma: a population-based study. Front Surg. 2021;8:804785. doi:10.3389/fsurg.2021.804785
ChenYCLuLFanKHWangDHFuWH. Proximal gastrectomy versus total gastrectomy for adenocarcinoma of the esophagogastric junction: a meta-analysis. J Comp Eff Res. 2019;8(10):753-766. doi:10.2217/cer-2019-0016
27.
KataiHSanoTFukagawaTShinoharaHSasakoM. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg. 2003;90(7):850-853. doi:10.1002/bjs.4106
28.
YamashitaHSetoYSanoTMakuuchiHAndoNSasakoMJapanese Gastric Cancer Association and the Japan Esophageal Society. Results of a nation-wide retrospective study of lymphadenectomy for esophagogastric junction carcinoma. Gastric Cancer. 2017;20(Suppl 1):69-83. doi:10.1007/s10120-016-0663-8
29.
YuraMYoshikawaTOtsukiSYamagataYMoritaSKataiHNishidaTYoshiakiT. Oncological safety of proximal gastrectomy for T2/T3 proximal gastric cancer. Gastric Cancer. 2019;22(5):1029-1035. doi:10.1007/s10120-019-00938-8
30.
RiMKumagaiKNamikawaKAtsumiSHayamiMMakuuchiRIdaSOhashiMSanoTNunobeS. Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach?Ann Gastroenterol Surg. 2021;5(6):767-775. doi:10.1002/ags3.12486
31.
TakeuchiHOyamaTKamiyaSNakamuraRTakahashiTWadaNSaikawaYKitagawaY. Laparoscopy-assisted proximal gastrectomy with sentinel node mapping for early gastric cancer. World J Surg. 2011;35(11):2463-2471. doi:10.1007/s00268-011-1223-3
32.
AnJYYounHGChoiMGNohJHSohnTSKimS. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg. 2008;196(4):587-591. doi:10.1016/j.amjsurg.2007.09.040
33.
RonellenfitschUNajmehSAndalibAPereraRMRousseauMCMulderDSFerriLE. Functional outcomes and quality of life after proximal gastrectomy with esophagogastrostomy using a narrow gastric conduit. Ann Surg Oncol. 2015;22(3):772-779. doi:10.1245/s10434-014-4078-7
34.
NunobeSIdaS. Current status of proximal gastrectomy for gastric and esophagogastric junctional cancer: a review. Ann Gastroenterol Surg. 2020;4(5):498-504. doi:10.1002/ags3.12365
35.
AhnSHLeeJHParkDJKimHH. Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer. 2013;16(3):282-289. doi:10.1007/s10120-012-0178-x
36.
AiharaRMochikiEKamiyamaYKamimuraHAsaoTKuwanoH. Mucin phenotypic expression in early signet ring cell carcinoma of the stomach: its relationship with the clinicopathologic factors. Dig Dis Sci. 2004;49(3):417-424. doi:10.1023/b:ddas.0000020496.98711.14
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