DO PROXIMAL AND DISTAL GASTRIC TUMOURS BEHAVE DIFFERENTLY?

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Gastric cancer remains a prevalent malignancy globally, despite declining incidence.
• Proximal gastric tumors are associated with poorer prognoses compared to distal tumors.

Purpose of the Study:

• To compare surgical outcomes and prognosis between proximal (excluding cardia) and distal gastric cancer.
• To evaluate the impact of lymph node dissection extent on survival in gastric cancer patients.

Main Methods:

• A retrospective review of 293 gastric cancer cases (209 distal, 69 proximal).
• Comparison of clinical features, pathological staging, surgical outcomes, mortality, and survival rates.
• Analysis of lymph node dissection techniques (D0, D1, D2) and outcomes.

Main Results:

• No significant differences in mortality, adjuvant chemotherapy, or radiation between proximal and distal gastric cancer groups.
• Significant differences observed in the extent of lymph node dissection (p=0.002) and number of positive lymph nodes (p=0.038).
• Patients undergoing D0 dissection had a 3x higher odds of 5-year death (OR 2.78) compared to D2 dissection; D1 dissection showed a 1.41x higher odds (OR 1.41).

Conclusions:

• While no significant differences were found between proximal and distal gastric cancer prognoses, survival is strongly influenced by lymph node dissection extent.
• Radical D2 lymph node dissection plays a critical role in enhancing survival for gastric cancer patients.
• Less extensive lymph node dissections (D0, D1) are associated with an increased risk of mortality.