Surgical and nutritional outcomes of laparoscopic proximal gastrectomy versus total gastrectomy: a meta-analysis

  • Toshiro TaniokaEmail author
  • Rawat Waratchanont
  • Ryosuke Fukuyo
  • Toshifumi Saito
  • Yuya Umebayashi
  • Emi Kanemoto
  • Kenta Kobayashi
  • Masatoshi Nakagawa
  • Mikito Inokuchi
Review Article



Laparoscopic proximal gastrectomy (LPG) is regarded as a less invasive surgery than laparoscopic total gastrectomy (LTG) for early gastric cancer located on the proximal side of the stomach. However, whether LPG is more effective than LTG remains unclear.


A systematic literature search of studies assessing short-term surgical and nutritional outcomes after LPG and LTG was conducted. A meta-analysis of surgical outcomes (operative time, intraoperative estimated blood loss, postoperative complications, and length of hospital stay) and nutritional outcomes (decrease in body weight, albumin, hemoglobin, total protein, and lymphocyte count) was then performed. All of 11 papers are a retrospective cohort study.


Eleven studies reported assessments of the above-mentioned outcomes in 883 patients. There was a trend towards shorter operative time and lower blood loss for LPG compared to LTG though not reaching statistical significance. Other surgical outcomes showed no significant differences. Patients who underwent LTG had a significantly lower body weight (95% confidence interval, 3.01–6.05, \(\bar{-}{x} \) = 4.53, p < 0.01) and hemoglobin level (95% confidence interval, 1.88–5.87, \( \bar{-}{x}\) = 3.87, p < 0.01) than patients who underwent LPG at 1 year after surgery. There were no significant differences in other nutritional outcomes.


These results indicate LPG had some advantages in postoperative nutrition. However, no significant differences in short-term surgical outcomes were noted between the two operations. Our analysis suggests that LPG may be more beneficial compared with LTG in terms of perioperative and nutritional outcomes for early-stage gastric cancer.


Gastric cancer Laparoscopic surgery Proximal gastrectomy Total gastrectomy Surgical outcomes Nutrition 



The authors have received no grant support or other forms of assistance.

Compliance with ethical standards


Drs. Toshiro Tanioka, Rawat Waratchanont, Ryosuke Fukuyo, Toshifumi Saito, Yuya Umebayashi, Emi Kanemoto, Kenta Kobayashi, Masatoshi Nakagawa, and Mikito Inokuchi have no conflicts of interest or financial ties to disclose.

Supplementary material

464_2019_7352_MOESM1_ESM.docx (16 kb)
Supplementary file1 (DOCX 15 kb)


  1. 1.
    Deans C, Yeo MS, Soe MY, Shabbir A, Ti TK, So JB (2011) Cancer of the gastric cardia is rising in incidence in an Asian population and is associated with adverse outcome. World J Surg 35:617–624CrossRefGoogle Scholar
  2. 2.
    Steevens J, Botterweck AA, Dirx MJ, van den Brandt PA, Schouten LJ (2010) Trends in incidence of oesophageal and stomach cancer subtypes in Europe. Eur J Gastroenterol Hepatol 22:669–678Google Scholar
  3. 3.
    Katai H, Sano T, Fukagawa T, Shinohara H, Sasako M (2003) Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 90:850–853CrossRefGoogle Scholar
  4. 4.
    Katai H, Morita S, Saka M, Taniguchi H, Fukagawa T (2010) Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg 97:558–562CrossRefGoogle Scholar
  5. 5.
    Shiraishi N, Adachi Y, Kitano S, Kakisako K, Inomata M, Yasuda K (2002) Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer. World J Surg 26:1150–1154CrossRefGoogle Scholar
  6. 6.
    Nozaki I, Hato S, Kobatake T, Ohta K, Kubo Y, Kurita A (2013) Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg 37:558–564CrossRefGoogle Scholar
  7. 7.
    Masuzawa T, Takiguchi S, Hirao M, Imamura H, Kimura Y, Fujita J, Miyashiro I, Tamura S, Hiratsuka M, Kobayashi K, Fujiwara Y, Mori M, Doki Y (2014) Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study. World J Surg 38:1100–1106CrossRefGoogle Scholar
  8. 8.
    Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19CrossRefGoogle Scholar
  9. 9.
    Aburatani T, Kojima K, Otsuki S, Murase H, Okuno K, Gokita K, Tomii C, Tanioka T, Inokuchi M (2017) Double-tract reconstruction after laparoscopic proximal gastrectomy using detachable ENDO-PSD. Surg Endosc 31:4848–4856CrossRefGoogle Scholar
  10. 10.
    Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S, Shirakawa Y, Fujiwara T (2016) Double-flap technique as an antireflux procedure in esophagogastrostomy after proximal gastrectomy. J Am Coll Surg 223:e7–e13CrossRefGoogle Scholar
  11. 11.
    Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148PubMedGoogle Scholar
  12. 12.
    Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K, Group JGCSS (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244CrossRefGoogle Scholar
  13. 13.
    Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH (2013) Prospective randomized controlled trial (phase III) to comparing laparoscopic distal gastrectomy with open distal gastrectomy for gastric adenocarcinoma (KLASS 01). J Korean Surg Soc 84:123–130CrossRefGoogle Scholar
  14. 14.
    Kim W, Kim HH, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee HJ, Korean Laparo-endoscopic Gastrointestinal Surgery Study Group (2016) Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg 263:28–35CrossRefGoogle Scholar
  15. 15.
    Nomura E, Kayano H, Lee SW, Kawai M, Machida T, Yamamoto S, Nabeshima K, Nakamura K, Mukai M, Uchiyama K (2019) Functional evaluations comparing the double-tract method and the jejunal interposition method following laparoscopic proximal gastrectomy for gastric cancer: an investigation including laparoscopic total gastrectomy. Surg Today 49:38–48CrossRefGoogle Scholar
  16. 16.
    Park JY, Park KB, Kwon OK, Yu W (2018) Comparison of laparoscopic proximal gastrectomy with double-tract reconstruction and laparoscopic total gastrectomy in terms of nutritional status or quality of life in early gastric cancer patients. Eur J Surg Oncol 44:1963–1970CrossRefGoogle Scholar
  17. 17.
    Cho M, Son T, Kim HI, Noh SH, Choi S, Seo WJ, Roh CK, Hyung WJ (2018) Similar hematologic and nutritional outcomes after proximal gastrectomy with double-tract reconstruction in comparison to total gastrectomy for early upper gastric cancer. Surg Endosc 33:1757–1768CrossRefGoogle Scholar
  18. 18.
    Sugiyama M, Oki E, Ando K, Nakashima Y, Saeki H, Maehara Y (2018) Laparoscopic proximal gastrectomy maintains body weight and skeletal muscle better than total gastrectomy. World J Surg 42:3270–3276CrossRefGoogle Scholar
  19. 19.
    Jung DH, Lee Y, Kim DW, Park YS, Ahn SH, Park DJ, Kim HH (2017) Laparoscopic proximal gastrectomy with double tract reconstruction is superior to laparoscopic total gastrectomy for proximal early gastric cancer. Surg Endosc 31:3961–3969CrossRefGoogle Scholar
  20. 20.
    Hayami M, Hiki N, Nunobe S, Mine S, Ohashi M, Kumagai K, Ida S, Watanabe M, Sano T, Yamaguchi T (2017) 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 24:1635–1642CrossRefGoogle Scholar
  21. 21.
    Nishigori T, Okabe H, Tsunoda S, Shinohara H, Obama K, Hosogi H, Hisamori S, Miyazaki K, Nakayama T, Sakai Y (2017) Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life. Surg Endosc 31:3664–3672CrossRefGoogle Scholar
  22. 22.
    Hosoda K, Yamashita K, Katada N, Moriya H, Mieno H, Shibata T, Sakuramoto S, Kikuchi S, Watanabe M (2016) Potential benefits of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy for cT1 upper-third gastric cancer. Surg Endosc 30:3426–3436CrossRefGoogle Scholar
  23. 23.
    Kosuga T, Ichikawa D, Komatsu S, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 22(Suppl 3):S929–935CrossRefGoogle Scholar
  24. 24.
    Ahn SH, Lee JH, Park DJ, Kim HH (2013) Comparative study of clinical outcomes between laparoscopy-assisted proximal gastrectomy (LAPG) and laparoscopy-assisted total gastrectomy (LATG) for proximal gastric cancer. Gastric Cancer 16:282–289CrossRefGoogle Scholar
  25. 25.
    Tsujimoto H, Uyama I, Yaguchi Y, Kumano I, Takahata R, Matsumoto Y, Yoshida K, Horiguchi H, Aosasa S, Ono S, Yamamoto J, Hase K (2012) Outcome of overlap anastomosis using a linear stapler after laparoscopic total and proximal gastrectomy. Langenbecks Arch Surg 397:833–840CrossRefGoogle Scholar
  26. 26.
    Kitano S, Shiraishi N, Fujii K, Yasuda K, Inomata M, Adachi Y (2002) A randomized controlled trial comparing open vs laparoscopy-assisted distal gastrectomy for the treatment of early gastric cancer: an interim report. Surgery 131:S306–311CrossRefGoogle Scholar
  27. 27.
    Kim DJ, Kim W (2016) Laparoscopy-assisted proximal gastrectomy with double tract anastomosis is beneficial for vitamin B12 and iron absorption. Anticancer Res 36:4753–4758CrossRefGoogle Scholar
  28. 28.
    Seo SH, Kim SE, Kang YK, Ryoo BY, Ryu MH, Jeong JH, Kang SS, Yang M, Lee JE, Sung MK (2016) Association of nutritional status-related indices and chemotherapy-induced adverse events in gastric cancer patients. BMC Cancer 16:900CrossRefGoogle Scholar
  29. 29.
    Fujiya K, Kawamura T, Omae K, Makuuchi R, Irino T, Tokunaga M, Tanizawa Y, Bando E, Terashima M (2018) Impact of malnutrition after gastrectomy for gastric cancer on long-term survival. Ann Surg Oncol 25:974–983CrossRefGoogle Scholar
  30. 30.
    Park YS, Son SY, Oo AM, do Jung H, Shin DJ, Ahn SH, do Park J, Kim HH (2016) Eleven-year experience with 3000 cases of laparoscopic gastric cancer surgery in a single institution: analysis of postoperative morbidities and long-term oncologic outcomes. Surg Endosc 30:3965–3975CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Gastric SurgeryTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Division of General Surgery, Department of SurgeryPhramongkutklao Hospital and College of MedicineBangkokThailand

Personalised recommendations