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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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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Toru Masuzawa, Shuji Takiguchi, Yoshiyuki Fujiwara, Masaki Mori & Yuichiro Doki

  2. Department of Surgery, Osaka National Hospital, Osaka, Japan

    Motohiro Hirao

  3. Department of Surgery, Sakai Municipal Hospital, Sakai, Japan

    Hiroshi Imamura

  4. Department of Surgery, NTT West Japan Hospital, Osaka, Japan

    Yutaka Kimura

  5. Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan

    Junya Fujita

  6. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Isao Miyashiro

  7. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan

    Shigeyuki Tamura

  8. Department of Surgery, Itami City Hospital, Itami, Japan

    Masahiro Hiratsuka

  9. Department of Surgery, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan

    Kenji Kobayashi

Authors
  1. Toru Masuzawa
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  2. Shuji Takiguchi
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  11. Yoshiyuki Fujiwara
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  12. Masaki Mori
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  13. Yuichiro Doki
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Corresponding author

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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  • DOI: https://doi.org/10.1007/s00268-013-2370-5

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