Retrospective Cohort Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2025; 17(5): 107579
Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.107579
Proximal gastrectomy with tubular stomach reconstruction vs total gastrectomy for proximal gastric cancer following neoadjuvant chemotherapy: A multicenter retrospective study
Yi-Ming Lu, Peng Jin, Hai-Kuo Wang, Xin-Xin Shao, Hai-Tao Hu, Yu-Juan Jiang, Wang-Yao Li, Yan-Tao Tian
Yi-Ming Lu, Hai-Kuo Wang, Xin-Xin Shao, Hai-Tao Hu, Yu-Juan Jiang, Wang-Yao Li, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Peng Jin, Department of Gastric Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Key Laboratory of Digestive Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
Co-first authors: Yi-Ming Lu and Peng Jin.
Author contributions: Lu YM, Jin P, Tian YT designed the study, collected the clinical data, contributed to the data analysis, manuscript writing, and funding support; Wang HK, Shao XX, Hu HT, Li WY contributed to the patient follow-up and verification of clinical data; Jiang YJ contributed to the methodology; and Tian YT controlled the quality and reviewed the manuscript. Lu YM and Jin P contributed equally to this work as co-first authors.
Supported by Special Fund for the Beijing Hope Marathon of the China Cancer Foundation, No. LC2019 L05; and the Capital Health Development Research Special Fund Project, No. 2024-2-4026.
Institutional review board statement: This study received approval from the Ethics Committee of the Cancer Hospital, Chinese Academy of Medical Sciences (21/489-3160).
Informed consent statement: Prior to treatment, all patients and their families provided informed consent, acknowledging and consenting to the potential use of clinical data collected during their treatment for future research. Therefore, when using retrospectively collected patient data, informed consent can be waived.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Tao Tian, MD, PhD, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Courtyard, Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: March 26, 2025
Revised: April 8, 2025
Accepted: April 25, 2025
Published online: May 27, 2025
Processing time: 58 Days and 0.4 Hours
Abstract
BACKGROUND

Gastric cancer (GC) is a major global health challenge, and the treatment of proximal GC in particular presents unique clinical and surgical complexities. Currently, there is no consensus on whether proximal gastrectomy (PG) or total gastrectomy (TG) should be used for advanced proximal GC, and the choice of postoperative gastrointestinal reconstruction method remains controversial.

AIM

To compare the short-term efficacy, long-term survival, and postoperative reflux outcomes of PG with tubular stomach reconstruction vs TG with Roux-en-Y reconstruction in patients with proximal GC following neoadjuvant chemotherapy (NACT) in an effort to provide valuable insights for clinical decision-making regarding the optimal surgical approach.

METHODS

A multicenter retrospective cohort study was conducted at two Chinese medical centers between December, 2012 and December, 2022. Patients with histologically confirmed proximal GC who received NACT followed by either PG with tubular stomach reconstruction or TG with Roux-en-Y reconstruction were included. Propensity score matching (PSM) was performed to balance baseline characteristics, and the primary endpoint was 5-year overall survival (OS). Secondary endpoints included recurrence-free survival (RFS), postoperative complications, and reflux severity.

RESULTS

After PSM, 244 patients (122 PG, 122 TG) were finally included and all baseline characteristics were comparable between groups. The PG group had a significantly shorter operation time compared to the TG group (189.50 vs 215.00 minutes, P < 0.001), with no differences in intraoperative blood loss or postoperative complications (19.68% vs 14.75%, P = 0.792). The 5-year OS rates were 52.7% vs 45.5% (P = 0.330), and 5-year RFS rates were 54.3% vs 47.6% (P = 0.356) for the PG and TG groups, respectively. Reflux symptoms (18.0% vs 31.1%, P = 0.017) and clinically significant reflux based on gastroesophageal reflux disease questionnaire scores ≥ 8 (7.4% vs 21.3%, P < 0.001) were significantly less frequent in the PG group. Multivariate analysis identified histological differentiation (HR = 2.98, 95%CI: 2.03-4.36, P < 0.001) and tumor size (HR = 0.26, 95%CI: 0.17-0.41 for tumors ≤ 4 cm, P < 0.001) as independent prognostic factors.

CONCLUSION

PG with tubular stomach reconstruction is comparable to TG in terms of surgical safety and long-term oncological outcomes for proximal GC patients following NACT. Additionally, PG has the advantages of shorter operation time and lower rates of postoperative reflux, suggesting potential benefits for patient quality of life. Notably, the analysis of postoperative prognostic factors, including histological differentiation and tumor size, further informs clinical decision-making and highlights the importance of individualized treatment strategies.

Keywords: Proximal gastric cancer; Proximal gastrectomy; Total gastrectomy; Neoadjuvant chemotherapy; Tubular stomach reconstruction; Reflux

Core Tip: This multicenter retrospective study compares proximal gastrectomy (PG) with tubular stomach reconstruction vs total gastrectomy (TG) for proximal gastric cancer following neoadjuvant chemotherapy. Our analysis of 244 propensity score-matched patients reveals that PG achieves comparable survival outcomes and surgical safety to TG, while offering significant advantages in operation time and postoperative reflux prevention. These findings support PG with tubular stomach reconstruction as a viable alternative to TG, potentially improving quality of life without compromising oncological efficacy in this patient population.