Proximal gastrectomy OK for proximal advanced gastric cancer

16 Sep 2022
Proximal gastrectomy OK for proximal advanced gastric cancer

For patients with proximal advanced gastric cancer (AGC), proximal gastrectomy (PG) appears to be a reasonable treatment option, particularly for those with small tumours, a recent study has found.

The study included 329 patients scheduled for surgery for proximal AGC. Most of the participants (n=254) received total gastrectomy, while 75 underwent PG. After propensity score matching, 67 patients remained in each surgery subgroup, which was statistically balanced in terms of baseline factors.

Five-year overall survival was 74.9 percent in PG patients, as opposed to 64.3 percent in those who received total gastrectomy. The difference was nominal and failed to reach significance (p=0.275). Stage-specific survival was likewise comparable between groups, though those with TNM stage III had better survival after PG vs total gastrectomy before matching (p=0.024).

Procedurally, both PG and total gastrectomy had similar operation times (p=0.429) and resulted in comparable blood loss volumes (p=0.793). Median postoperative stay, however, was significantly lower in the PG group (median, 12 vs 14 days; p=0.003).

Multivariate Cox regression analysis revealed that tumour diameter >4 cm was a significant risk factor for death in AGC patients (hazard ratio [HR], 1.917, 95 percent confidence interval [CI], 1.188–3.094; p=0.008) as was the presence of lymph node metastasis (HR, 1.944, 95 percent CI, 1.171–3.230; p=0.01).

The use of PG vs TG was only borderline protective against death (HR, 0.523, 95 percent CI, 0.254–1.076; p=0.078).

Editor's Recommendations
Related Diseases