Surgical choice of proximal gastric cancer in China: a retrospective study of a 30-year experience from a single center in China

ABSTRACT

Background: Total gastrectomy with D2 lymphadenectomy is indicated for proximal advanced gastric cancer located in the upper one-third of the stomach; however, due to preserved function and clinical benefits of a proximal gastrectomy, the choice of a surgical method for patients with proximal early-stage gastric cancer remains controversial.

Methods: We conducted a retrospective study involving 649 patients with proximal gastric cancer. The clinical-pathological features, characteristics, lymph node metastatic patterns, prognosis, postoperative complications, and recurrence were compared between the patients who underwent proximal and total gastrectomies with different T and N stages.

Results: The lymph node metastatic rates among T stages were significantly different. There was no difference in overall survival rates for stage Ia, Ib, and IIa patients but significant difference in T3 and T4 stages who underwent proximal and total gastrectomy. Complications were more frequently detected in patients who underwent total gastrectomy than proximal gastrectomy.

Conclusion: Considering the survival benefits and preserved function, proximal gastrectomy can be performed safely in stage Ia and Ib gastric cancer (T1N0, T1N1, and T2N0) with an excellent remission rate. Proximal gastrectomy is not recommended for advanced gastric cancer.

KEYWORDS:

• Proximal gastric cancer
• total gastrectomy
• proximal gastrectomy
• prognosis
• lymph node
• metastasis

Article highlights

• We proposed more accurate surgical indications for patients with proximal gastric cancer.

• Proximal gastrectomy can be performed safely in stage Ia and Ib gastric cancer (T1N0, T1N1, and T2N0) with an excellent remission rate considering the survival benefits and preserved function.

• Complications appeared more frequently in patients who underwent total gastrectomy than proximal gastrectomy.

• Peritoneal metastasis was independently correlated with total gastrectomy and locoregional recurrence was independently correlated with proximal gastrectomy.

Acknowledgments

The authors would like to thank all the physicians and nurses involved in this study for their contributions.

Authors’ contributions

Z. Zhu and H. Xu contributed to conception and design of the study, and drafted the manuscript; P. Wu, N. Du and K. Li contributed to analysis and interpretation of data and revised the manuscript. B. Huang and Z. Wang participated in data acquisition and literature research. All authors read and approved the final manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was supported by the National Natural Science Foundation of China [Grant No. 81772549].