Fausto Rosa1, Giuseppe Quero2, Claudio Fiorillo2, Massimiliano Bissolati3, Chiara Cipollari4, Stefano Rausei5, Damiano Chiari3, Laura Ruspi5, Giovanni de Manzoni4, Guido Costamagna6, Giovanni Battista Doglietto2, Sergio Alfieri2. 1. Department of Digestive Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy. faust.rosa@tiscali.it. 2. Department of Digestive Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy. 3. Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy. 4. 1st Division of Surgery, University of Verona, Verona, Italy. 5. Department of Surgical Sciences, University of Insubria (Varese-Como), Varese, Italy. 6. Department of Digestive Endoscopy, "A. Gemelli" Hospital, Catholic University of Rome, Rome, Italy.
Abstract
BACKGROUND: The aim of this study is to compare surgical outcomes including postoperative complications and prognosis between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer (GC). Propensity-score-matching analysis was performed to overcome patient selection bias between the two surgical techniques. METHODS: Among 457 patients who were diagnosed with GC between January 1990 and December 2010 from four Italian institutions, 91 underwent PG and 366 underwent TG. Clinicopathologic features, postoperative complications, and survivals were reviewed and compared between these two groups retrospectively. RESULTS: After propensity-score matching had been done, 150 patients (75 TG patients, 75 PG patients) were included in the analysis. The PG group had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the TG group. N stages and 5-year survival rates were similar after TG and PG. Postoperative complication rates after PG and TG were 25.3 and 28%, respectively, (P = 0.084). Rates of reflux esophagitis and anastomotic stricture were 12 and 6.6% after PG and 2.6 and 1.3% after TG, respectively (P < 0.001 and P = 0.002). 5-year overall survival for PG and TG group was 56.7 and 46.5%, respectively (P = 0.07). Survival rates according to the tumor stage were not different between the groups. Multivariate analysis showed that type of resection was not an independent prognostic factor. CONCLUSION: Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.
BACKGROUND: The aim of this study is to compare surgical outcomes including postoperative complications and prognosis between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer (GC). Propensity-score-matching analysis was performed to overcome patient selection bias between the two surgical techniques. METHODS: Among 457 patients who were diagnosed with GC between January 1990 and December 2010 from four Italian institutions, 91 underwent PG and 366 underwent TG. Clinicopathologic features, postoperative complications, and survivals were reviewed and compared between these two groups retrospectively. RESULTS: After propensity-score matching had been done, 150 patients (75 TGpatients, 75 PGpatients) were included in the analysis. The PG group had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the TG group. N stages and 5-year survival rates were similar after TG and PG. Postoperative complication rates after PG and TG were 25.3 and 28%, respectively, (P = 0.084). Rates of reflux esophagitis and anastomotic stricture were 12 and 6.6% after PG and 2.6 and 1.3% after TG, respectively (P < 0.001 and P = 0.002). 5-year overall survival for PG and TG group was 56.7 and 46.5%, respectively (P = 0.07). Survival rates according to the tumor stage were not different between the groups. Multivariate analysis showed that type of resection was not an independent prognostic factor. CONCLUSION: Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.
Entities:
Keywords:
Proximal gastrectomy; Total gastrectomy; Upper third gastric cancer
Authors: Paul J Karanicolas; Dennis Graham; Mithat Gönen; Vivian E Strong; Murray F Brennan; Daniel G Coit Journal: Ann Surg Date: 2013-06 Impact factor: 12.969