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

• DOI: 10.1007/s00268-013-2370-5
• Publication Date: 2013-12-05T16:26:01Z
• Authors: Toru Masuzawa; Shuji Takiguchi; Motohiro Hirao; Hiroshi Imamura; Yutaka Kimura; Junya Fujita; Isao Miyashiro; Shigeyuki Tamura; Masahiro Hiratsuka; Kenji Kobayashi; Yoshiyuki Fujiwara; Masaki Mori; Yuichiro Doki
• Keywords: Male; Time Factors; Adenocarcinoma; Middle Aged; 3. Good health; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Gastrectomy; Stomach Neoplasms; Humans; Female; Aged; Retrospective Studies

AbstractBackgroundVarious surgical procedures are used to treat early gastric cancers in the upper third of the stomach (U‐EGCs). However, there is no general agreement regarding the optimal surgical procedure.MethodsThe medical records of 203 patients with U‐EGC were collected from 13 institutions. Surgical procedures were classified as Roux‐en‐Y esophagojejunostomy after total gastrectomy (TG‐RY), esophagogastrostomy after proximal gastrectomy (PG‐EG), or jejunal interposition after PG (PG‐JI). Patient clinical characteristics and perioperative and long‐term outcomes were compared among these three groups.ResultsTG‐RY, PG‐EG, and PG‐JI were performed in 122, 49, and 32 patients, respectively. Tumors were larger in TG‐RY patients than in PG‐EG and PG‐JI patients, and undifferentiated‐type gastric adenocarcinoma tended to be more frequent in TG‐RY than in PG‐EG. The operative time was shorter for PG‐EG than for PG‐JI and TG‐RY. Hospital stay and early postoperative complications were not different for the three procedures. With respect to gastrectomy‐associated symptoms, a “stuck feeling” and heartburn tended to be more frequent in PG‐EG patients, while dumping syndrome and diarrhea were more frequent in TG‐RY patients. Post‐surgical weight loss was not different among the three groups, however, serum albumin and hemoglobin levels tended to be lower in TG‐RY patients.ConclusionThree 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.