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Long-term Outcome after Proximal Gastrectomy with Jejunal Interposition for Gastric Cancer Compared with Total Gastrectomy

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Abstract

Background

Proximal gastrectomy (PG) has been widely accepted as treatment for early gastric cancer located in the upper third of the stomach. Reconstruction by jejunal interposition has been known to reduce reflux esophagitis for PG patients. The aim of this study was to compare the long-term outcomes of patients who underwent PG with jejunal interposition with those treated by total gastrectomy (TG).

Methods

Data on 102 cases of PG with jejunal interposition and 49 cases of TG with Roux-Y reconstruction for gastric cancer were analyzed retrospectively in terms of overall survival, weight maintenance, anemia and nutritional status, and endoscopic findings.

Results

Median follow-up time was 59 months in the both groups. There was no significant difference in the overall 5-year survival rate between the PG group (94 %) and the TG group (84 %). The PG group showed significantly better body weight maintenance at the first year. The laboratory blood tests showed that the PG group had a significantly better red blood cell count and hemoglobin and hematocrit levels at the second and third year. However, postoperative endoscopic surveillance detected reflux esophagitis (3 %), peptic ulcer (9 %), and metachronous gastric cancer (5 %) in the PG group.

Conclusions

Proximal gastrectomy maintains comparable oncological radicality to TG and is preferred over TG in terms of preventing postoperative anemia. However, periodic endoscopic follow-up is necessary to monitor the upper gastrointestinal tract.

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Conflict of interest

I. Nozaki, S. Hato, T. Kobatake, K. Ohta, Y. Kubo, and A. Kurita have no conflicts of interest to disclose. This work was supported in part by the National Cancer Center Research and Development Fund (23-A-19).

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Surgery, Shikoku Cancer Center, 160 Minami-umemoto, Matsuyama, 791-0280, Japan

    Isao Nozaki, Shinji Hato, Takaya Kobatake, Koji Ohta, Yoshirou Kubo & Akira Kurita

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  1. Isao Nozaki
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  2. Shinji Hato
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  3. Takaya Kobatake
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  4. Koji Ohta
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  5. Yoshirou Kubo
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  6. Akira Kurita
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Correspondence to Isao Nozaki.

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Nozaki, I., Hato, S., Kobatake, T. et al. Long-term Outcome after Proximal Gastrectomy with Jejunal Interposition for Gastric Cancer Compared with Total Gastrectomy. World J Surg 37, 558–564 (2013). https://doi.org/10.1007/s00268-012-1894-4

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