Abstract
BACKGROUND
Proximal gastric cancer (PGC) is more common in the West than in the East. Improvements related to the minimally invasive approach in GC surgery and benefits to quality of life may be reasons for adopting proximal gastrectomy (PG). This study aimed to compare short- and long-term oncologic and surgical outcomes among patients with PGC with advanced PGC undergoing total gastrectomy (TG) vs PG in 2 expert centers in a European population.
METHODS
Patients with locally advanced PGC treated between 2010 and 2020 were included in the study. Patients who had not undergone gastrectomy, had early or metastatic GC, underwent palliative care, or had incomplete clinical or pathologic information were excluded. Propensity score matching (PSM) analysis was used to balance known covariates.
RESULTS
After PSM, patients who underwent TG had a higher incidence of positive margins (19.1% vs 8.6%; P =.0064), a higher median number of harvested lymph nodes (LNs) (26 vs 18 LNs; P <.0001), and a higher incidence of serious postoperative complications (35.2% vs 20.4%; P =.0030) than individuals who underwent PG. Older age (≥65 years) was related to a higher risk of serious postoperative complications (odds ratio [OR], 1.91). The use of neoadjuvant chemotherapy was related to a lower risk of serious postoperative complications (OR, 0.36). TG was independently associated with a higher risk of serious postoperative complications (OR, 2.02). Median overall survival for PG and TG groups was 44 and 23 months, respectively (hazard ratio, 1.22; 95% CI, 0.94-1.60; P =.1340).
CONCLUSION
PG may be considered as an alternative approach to TG in well-selected patients with locally advanced PGC. This surgical approach was associated with fewer serious postoperative complications.
