Proximal Versus Total Gastrectomy in Elderly Patients With Upper Gastric Cancer

The optimal extent of gastrectomy for elderly patients with upper gastric cancer (GC) remains controversial. This study compared short-term surgical outcomes and mid-term nutritional changes between proximal gastrectomy (PG) and total gastrectomy (TG) in patients aged ≥75 years.

This retrospective cohort study included 27 elderly patients with upper GC who underwent laparoscopic TG (n=13) or PG (n=14) between 2014 and 2023. Short-term outcomes included operative variables, postoperative complications, and length of hospital stay. Mid-term outcomes included reflux esophagitis, anastomotic stricture, and longitudinal changes in body weight, hemoglobin levels, and albumin levels up to 2 years postoperatively. A subgroup analysis was performed for patients aged ≥80 years.

The PG group consisted exclusively of patients with clinical T1 disease, whereas the TG group included patients with more advanced tumors. Postoperative complications occurred in 31% of patients in the TG group and 14% of patients in the PG group. The median length of postoperative hospital stay was significantly shorter in the PG group (12 vs. 15 days, p=0.048). Postoperative weight loss was consistently greater in the TG group, with a significant difference at one month. The decline in serum hemoglobin levels was significantly greater in the TG group at one and two years. No significant differences were observed in albumin levels. In patients aged ≥80 years, PG showed numerically favorable trends in complication rates, length of hospital stay, and nutritional parameters.

PG may provide short- and mid-term functional advantages over TG in elderly patients with upper GC, while maintaining acceptable surgical safety. Function-preserving surgery should be considered for appropriately selected elderly patients.