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

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Abstract

Background

Various 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.

Methods

The 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.

Results

TG-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.

Conclusion

Three 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.

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Acknowledgments

We thank the other authors and hospitals that have not been listed on the title page: Chikara Ebisui, Department of Surgery, Hyogo Prefectural Nishinomiya Hospital; Yoichiro Nushijima, Department of Surgery, Kawanishi City Hospital; Jin Matsuyama, Department of Surgery, Yao Municipal Hospital; and Minoru Kawai, Department of Surgery, Uchinomi Hospital.

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Correspondence to Shuji Takiguchi.

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Masuzawa, T., Takiguchi, S., Hirao, M. et al. 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, 1100–1106 (2014). https://doi.org/10.1007/s00268-013-2370-5

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