Preview

Experimental and Clinical Gastroenterology

Advanced search

Does proximal gastrectomy work better versus total gastrectomy in proximal gastric cancers? A Comparative analytic study

https://doi.org/10.31146/1682-8658-ecg-219-11-40-46

Abstract

Background and aim: The ideal extent of resection in proximal gastric cancer is still controversial and there is no general consensus. Therefore, this study was designed to compare the results of proximal gastrectomy versus total gastrectomy in patients with proximal gastric cancer. Methods: One hundred forty-six patients who underwent total (n=96) or proximal (n=50) gastrectomy due to proximal gastric cancer in Firoozgar Hospital, in Tehran, Iran in 2015 and 2021 were enrolled. Patients were classified and evaluated according to age, sex, duration of hospitalization, 30-day mortality, histological grading and stage, resection margin, lymph node involvement, and overall survival. Results: Patients who underwent proximal gastrectomy had a significantly longer survival (P=0.025). There was no statistically significant difference between the two groups in terms of the number of lymph nodes removed and the status of resected margin. Cox regression analysis showed that the number of positive lymph nodes, undergoing splenectomy and grade of invasion were associated with decreased survival (P<0.05). Conclusion: The optimal treatment for proximal gastric cancer is not yet known. Although patients with proximal gastric cancer who underwent proximal gastrectomy had better survival, it might be due to the confounding effect of a grade of invasion, which needs further investigations in this field.

About the Authors

Wadji M. Baghai
Iran University of Medical Sciences
Russian Federation


A. . Kashanizadeh
Iran University of Medical Sciences
Russian Federation


S. . Sabouri
Iran University of Medical Sciences
Russian Federation


S. . Ahmadi
Iran University of Medical Sciences
Russian Federation


M. . Moradi
Iran University of Medical Sciences
Russian Federation


M. . Kashanizadeh
Iran University of Medical Sciences
Russian Federation


A. . Madankan
Iran University of Medical Sciences
Russian Federation


References

1. Machlowska J., Baj J., Sitarz M., Maciejewski R., Sitarz R. Gastric Cancer: Epidemiology, Risk Factors, Classification, Genomic Characteristics and Treatment Strategies.Int J Mol Sci. 2020 Jun 4;21(11):4012. doi: 10.3390/ijms21114012.

2. Petryszyn P., Chapelle N., Matysiak-Budnik T. Gastric Cancer: Where Are We Heading? Dig Dis. 2020;38(4): 280-285. doi: 10.1159/000506509.

3. Smyth E.C., Nilsson M., Grabsch H.I., van Grieken N.C., Lordick F. Gastric cancer. Lancet. 2020 Aug 29;396(10251):635-648. doi: 10.1016/S0140-6736(20)31288-5.

4. Hu B., El Hajj N., Sittler S., Lammert N., Barnes R., Meloni-Ehrig A. Gastric cancer: Classification, histology and application of molecular pathology. J Gastrointest Oncol. 2012 Sep;3(3):251-61. doi: 10.3978/j.issn.2078-6891.2012.021.

5. Siegel R., Ma J., Zou Z., Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014 Jan-Feb;64(1):9-29. doi: 10.3322/caac.21208.

6. Sadighi S., Raafat J., Mohagheghi M., Meemary F. Gastric carcinoma: 5 year experience of a single institute. Asian Pac J Cancer Prev. 2005 Apr-Jun;6(2):195-6. PMID: 16101332.

7. Biagioni A., Skalamera I., Peri S., Schiavone N., Cianchi F., Giommoni E., Magnelli L., Papucci L. Update on gastric cancer treatments and gene therapies. Cancer Metastasis Rev. 2019 Sep;38(3):537-548. doi: 10.1007/s10555-019-09803-7.

8. Sun K.K., Wu Y.Y. Current status of laparoscopic proximal gastrectomy in proximal gastric cancer: Technical details and oncologic outcomes. Asian J Surg. 2021 Jan; 44(1):54-58. doi: 10.1016/j.asjsur.2020.09.006.

9. Papachristou D.N., Fortner J.G. Adenocarcinoma of the gastric cardia. The choice of gastrectomy. Ann Surg. 1980 Jul;192(1):58-64. doi: 10.1097/00000658-198007000-00010.

10. Jakl R.J., Miholic J., Koller R., Markis E., Wolner E. Prognostic factors in adenocarcinoma of the cardia. Am J Surg. 1995 Mar;169(3):316-9. doi: 10.1016/s0002-9610(99)80166-4.

11. Nagayo T. Background data to the study of advanced gastric cancer. Histogenesis and Precursors of Human. Gastric Cancer: Springer; 1986. p. 17-39.

12. Rugge M, Fassan M, Graham DY. Epidemiology of gastric cancer. Gastric Cancer: Springer; 2015. p. 23-34.

13. Crew K.D., Neugut A.I. Epidemiology of gastric cancer. World J Gastroenterol. 2006 Jan 21;12(3):354-62. doi: 10.3748/wjg.v12.i3.354.

14. Katai H. Function-preserving surgery for gastric cancer.Int J Clin Oncol. 2006 Oct;11(5):357-66. doi: 10.1007/s10147-006-0613-2.

15. Maruyama K., Gunvén P., Okabayashi K., Sasako M., Kinoshita T. Lymph node metastases of gastric cancer. General pattern in 1931 patients. Ann Surg. 1989 Nov;210(5): 596-602. doi: 10.1097/00000658-198911000-00005.

16. Son M.W., Kim Y.J., Jeong G.A., Cho G.S., Lee M.S. Long-Term Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Upper-Third Gastric Cancer. J Gastric Cancer. 2014 Dec;14(4):246-51. doi: 10.5230/jgc.2014.14.4.246.

17. Harrison L.E., Karpeh M.S., Brennan M.F. Total gastrectomy is not necessary for proximal gastric cancer. Surgery. 1998;123(2):127-30.

18. Ichikawa D., Ueshima Y., Shirono K. et al. Esophagogastrostomy reconstruction after limited proximal gastrectomy. Hepatogastroenterology. 2001 Nov-Dec; 48(42):1797-801. PMID: 11813627.

19. Sugoor P., Shah S., Dusane R., Desouza A., Goel M., Shrikhande S.V. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbecks Arch Surg. 2016 Aug;401(5):687-97. doi: 10.1007/s00423-016-1422-3.

20. Son M.W., Kim Y.J., Jeong G.A., Cho G.S., Lee M.S. Long-Term Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Upper-Third Gastric Cancer. J Gastric Cancer. 2014 Dec;14(4):246-51. doi: 10.5230/jgc.2014.14.4.246.

21. Zhao L., Ling R., Chen J., Shi A., Chai C., Ma F., Zhao D., Chen Y. Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis. Dig Surg. 2021;38(1):1-13. doi: 10.1159/000506104.

22. Yoo C.H., Sohn B.H., Han W.K., Pae W.K. Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach. Cancer Res Treat. 2004 Feb;36(1):50-5. doi: 10.4143/crt.2004.36.1.50.

23. An J.Y., Youn H.G., Choi M.G., Noh J.H., Sohn T.S., Kim S. The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg. 2008 Oct;196(4):587-91. doi: 10.1016/j.amjsurg.2007.09.040.

24. Zhao L., Ling R., Chen J., Shi A., Chai C., Ma F., Zhao D., Chen Y. Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis. Dig Surg. 2021;38(1):1-13. doi: 10.1159/000506104.

25. Katai H., Morita S., Saka M., Taniguchi H., Fukagawa T. Long-term outcome after proximal gastrectomy with jejunal interposition for suspected early cancer in the upper third of the stomach. Br J Surg. 2010 Apr;97(4):558-62. doi: 10.1002/bjs.6944.

26. Moreaux J., Msika S. Carcinoma of the gastric cardia: surgical management and long-term survival. World J Surg. 1988 Apr;12(2):229-35. doi: 10.1007/BF01658061.


Review

For citations:


Baghai W.M., Kashanizadeh A., Sabouri S., Ahmadi S., Moradi M., Kashanizadeh M., Madankan A. Does proximal gastrectomy work better versus total gastrectomy in proximal gastric cancers? A Comparative analytic study. Experimental and Clinical Gastroenterology. 2023;(11):40-46. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-219-11-40-46

Views: 239


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1682-8658 (Print)