Makoto Yamasaki1, S Takiguchi2, T Omori3, M Hirao4, H Imamura5, K Fujitani6, S Tamura7, Y Akamaru8, K Kishi9, J Fujita10, T Hirao11, K Demura11, J Matsuyama12, A Takeno13, C Ebisui14, K Takachi15, O Takayama16, H Fukunaga17, K Okada18, S Adachi19, S Fukuda20, N Matsuura21, T Saito21, T Takahashi21, Y Kurokawa21, M Yano14, H Eguchi21, Y Doki21. 1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan. myamasaki@gesurg.med.osaka-u.ac.jp. 2. Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 3. Department of Surgery, Osaka International Cancer Institute, Osaka, Japan. 4. Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan. 5. Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan. 6. Department of Surgery, Osaka General Medical Center, Osaka, Japan. 7. Department of Surgery, Yao Municipal Hospital, Osaka, Japan. 8. Department of Surgery, Ikeda Municipal Hospital, Osaka, Japan. 9. Department of Surgery, Osaka Police Hospital, Osaka, Japan. 10. Department of Surgery, Sakai City Medical Center, Osaka, Japan. 11. Department of Surgery, Japan Community Health Care Organization Osaka Hospital, Osaka, Japan. 12. Department of Surgery, Higashiosaka City Medical Center, Osaka, Japan. 13. Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan. 14. Department of Surgery, Suita Municipal Hospital, Osaka, Japan. 15. Department of Surgery, Kinki Central Hospital, Hyogo, Japan. 16. Department of Surgery, Saiseikai Senri Hospital, Osaka, Japan. 17. Department of Surgery, Itami Municipal Hospital, Osaka, Japan. 18. Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Hyogo, Japan. 19. Department of Surgery, Nishinomiya Municipal Central Hospital, Hyogo, Japan. 20. Department of Surgery, Kindai University Nara Hospital, Osaka, Japan. 21. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0879, Japan.
Abstract
BACKGROUND: The appropriate surgical procedure for patients with upper third early gastric cancer is controversial. We compared total gastrectomy (TG) with proximal gastrectomy (PG) in this patient population. METHODS: A multicenter, non-randomized trial was conducted, with patients treated with PG or TG. We compared short- and long-term outcomes between these procedures. RESULTS: Between 2009 and 2014, we enrolled 254 patients from 22 institutions; data from 252 were included in the analysis. These 252 patients were assigned to either the PG (n = 159) or TG (n = 93) group. Percentage of body weight loss (%BWL) at 1 year after surgery, i.e., the primary endpoint, in the PG group was significantly less than that of the TG group (- 12.8% versus - 16.9%; p = 0.0001). For short-term outcomes, operation time was significantly shorter for PG than TG (252 min versus 303 min; p < 0.0001), but there were no group-dependent differences in blood loss and postoperative complications. For long-term outcomes, incidence of reflux esophagitis in the PG group was significantly higher than that of the TG group (14.5% versus 5.4%; p = 0.02), while there were no differences in the incidence of anastomotic stenosis between the two (5.7% versus 5.4%; p = 0.92). Overall patient survival rates were similar between the two groups (3-year survival rates: 96% versus 92% in the PG and TG groups, respectively; p = 0.49). CONCLUSIONS: Patients who underwent PG were better able to control weight loss without worsening the prognosis, relative to those in the TG group. Optimization of a reconstruction method to reduce reflux in PG patients will be important.
BACKGROUND: The appropriate surgical procedure for patients with upper third early gastric cancer is controversial. We compared total gastrectomy (TG) with proximal gastrectomy (PG) in this patient population. METHODS: A multicenter, non-randomized trial was conducted, with patients treated with PG or TG. We compared short- and long-term outcomes between these procedures. RESULTS: Between 2009 and 2014, we enrolled 254 patients from 22 institutions; data from 252 were included in the analysis. These 252 patients were assigned to either the PG (n = 159) or TG (n = 93) group. Percentage of body weight loss (%BWL) at 1 year after surgery, i.e., the primary endpoint, in the PG group was significantly less than that of the TG group (- 12.8% versus - 16.9%; p = 0.0001). For short-term outcomes, operation time was significantly shorter for PG than TG (252 min versus 303 min; p < 0.0001), but there were no group-dependent differences in blood loss and postoperative complications. For long-term outcomes, incidence of reflux esophagitis in the PG group was significantly higher than that of the TG group (14.5% versus 5.4%; p = 0.02), while there were no differences in the incidence of anastomotic stenosis between the two (5.7% versus 5.4%; p = 0.92). Overall patient survival rates were similar between the two groups (3-year survival rates: 96% versus 92% in the PG and TG groups, respectively; p = 0.49). CONCLUSIONS: Patients who underwent PG were better able to control weight loss without worsening the prognosis, relative to those in the TG group. Optimization of a reconstruction method to reduce reflux in PG patients will be important.
Entities:
Keywords:
Proximal gastrectomy; Total gastrectomy; Upper third gastric cancer
Authors: Jessie Steevens; Anita A M Botterweck; Miranda J M Dirx; Piet A van den Brandt; Leo J Schouten Journal: Eur J Gastroenterol Hepatol Date: 2010-06 Impact factor: 2.566