Proximal Versus Total Gastrectomy in Elderly Patients With Upper Gastric Cancer

Area of Science:

• Oncology
• Surgical Gastroenterology
• Geriatric Medicine

Background:

• Optimal gastrectomy extent for elderly upper gastric cancer is debated.
• Proximal gastrectomy (PG) and total gastrectomy (TG) are surgical options.
• Elderly patients (≥75 years) present unique challenges in gastric cancer treatment.

Purpose of the Study:

• Compare short-term surgical outcomes of PG vs. TG in elderly patients (≥75 years) with upper gastric cancer.
• Evaluate mid-term nutritional changes and complications following PG and TG.
• Assess outcomes in a subgroup of very elderly patients (≥80 years).

Main Methods:

• Retrospective cohort study of 27 elderly patients undergoing laparoscopic TG (n=13) or PG (n=14).
• Collected data on operative variables, postoperative complications, and hospital stay.
• Monitored nutritional status (weight, hemoglobin, albumin) and complications up to 2 years post-surgery.

Main Results:

• PG group had T1 disease; TG group had more advanced tumors.
• Lower complication rates (14% vs. 31%) and shorter hospital stay (12 vs. 15 days) in the PG group.
• Greater weight loss and hemoglobin decline at 1-2 years post-TG; no significant albumin differences. Favorable trends for PG in ≥80 subgroup.

Conclusions:

• Proximal gastrectomy (PG) may offer functional advantages over total gastrectomy (TG) in elderly upper gastric cancer patients.
• PG demonstrates acceptable surgical safety with potential short- and mid-term benefits.
• Function-preserving surgery should be considered for appropriately selected elderly gastric cancer patients.