Proximal gastrectomy with tubular stomach reconstruction vs total gastrectomy for proximal gastric cancer following neoadjuvant chemotherapy: A multicenter retrospective study

Table 1 Baseline characters of proximal and total gastrectomy groups after propensity score matching, n (%)

	TG (n = 122)	PG (n = 122)	P value
Gender			1.000
Male	98 (80.3)	98 (80.3)
Female	24 (19.7)	24 (19.7)
Age1, years	63.00 (59.50-68.25)	62.00 (58.00-67.00)	0.453
BMI1, kg/m2	24.11 (21.44-25.91)	23.40 (21.50-25.95)	0.673
ASA score			0.697
1-2	108 (88.5)	106 (86.9)
3	14 (11.5)	16 (13.1)
CCI score			0.494
≤ 2	80 (65.6)	85 (69.7)
> 2	42 (34.4)	37 (30.3)
Tumor size1, cm	3.00 (2.00-4.50)	3.00 (2.00-4.00)	0.771
Histologic differentiation			0.324
Poor/other types	72 (59.02)	61 (50.00)
Moderate	45 (36.89)	53 (43.44)
Well	13 (5.33)	8 (6.56)
Number of lymph nodes retrieved1	31.00 (22.75-4100)	32.50 (23.75-43.00)	0.455
Number of lymph node metastasis1, n	2.00 (0.00-8.00)	2.00 (0.00-5.25)	0.381
ypT stage			0.269
ypT0	16 (13.11)	19 (15.57)
ypT1a	9 (7.38)	4 (3.28)
ypT1b	10 (8.20)	5 (4.10)
ypT2	12 (9.84)	18 (14.75)
ypT3	33 (27.05)	25 (20.49)
ypT4a	40 (32.79)	50 (40.98)
ypT4b	2 (1.64)	1 (0.82)
ypN stage			0.509
ypN0	49 (40.16)	48 (39.34)
ypN1	21 (17.21)	22 (18.03)
ypN2	21 (17.21)	30 (24.59)
ypN3a	24 (19.67)	18 (14.75)
ypN3b	7 (5.74)	4 (3.28)
ypTNM stage
0	20 (16.4)	19 (15.6)
I	9 (7.4)	15 (12.3)
II	40 (32.8)	30 (24.6)
III	53 (43.4)	58 (47.5)
Vascular invasion			0.328
No	82 (67.2)	89 (73.0)
Yes	40 (32.8)	33 (27.0)
Perineural invasion			0.419
No	77 (63.1)	83 (68.0)
Yes	45 (36.9)	39 (32.0)	1.000
Radical resection
R0	121 (99.18)	120 (98.36)
R1/R2	1 (0.82)	2 (1.64)

¹Values are presented as median (Q1-Q3).

ASA: American Society of Anesthesiologists; CCI: Charlson comorbidity index; NACT: Neoadjuvant chemotherapy; PG: Proximal gastrectomy; TG: Total gastrectomy; TG: Total gastrectomy; BMI: Body mass index.

Table 2 Clinical outcomes of neoadjuvant chemotherapy, n (%)

	TG (n = 122)	PG (n = 122)	P value
NACT regimen			0.778
SOX	57 (46.72)	61 (50.00)
CAPEOX	15 (12.30)	15 (12.30)
DOS	20 (16.39)	15 (12.30)
FLOT	10 (8.20)	15 (12.30)
FOLFOX	5 (4.10)	3 (2.46)
Other	15 (12.30)	13 (10.66)
NACT cycles			0.251
1	4 (3.28)	7 (5.74)
2	18 (14.75)	14 (11.48)
3	37 (30.33)	36 (29.51)
4	46 (37.70)	56 (45.90)
6	13 (10.06)	9 (7.38)
> 6	4 (3.28)	7 (5.74)
TRG (Becker)			< 0.001
1a	6 (4.92)	21 (17.21)
1b	19 (15.57)	13 (10.66)
2	72 (59.02)	30 (24.59)
3	25 (20.49)	58 (47.54)
CR response			0.005
CR	4 (3.28)	16 (13.11)
Non-CR	118 (96.72)	106 (86.89)
Plus immunotherapy			0.797
Yes	23 (18.85)	30 (24.59)
No	99 (81.15)	92 (75.41)

NACT: Neoadjuvant chemotherapy treatment; PG: Proximal gastrectomy; TG: Total gastrectomy; TRG: Tumor regression grade; CR: Complete response.

Table 3 Clinical outcomes of surgery and postoperative morbidity, n (%)

	TG (n = 122)	PG (n = 122)	P value
Surgical approach			0.915
Laparoscopic	84 (68.85)	81 (66.39)
Open	30 (24.59)	32 (26.23)
Robotic	8 (6.56)	9 (7.38)
Operation time1, minutes	215 (195.00-248.75)	189.50 (169.25-227.25)	< 0.001
Blood loss1, mL	100.00 (100.00-200.00)	100.00 (100.00-200.00)	0.445
Hospitalization time1, days	10.00 (9.00-12.00)	11.00 (8.00-13.75)	0.314
Postoperative complications			0.792
No complications	104 (85.25)	98 (80.32)	0.186
Anastomotic leakage	2 (1.64)	2 (1.64)	1.000
Anastomotic stricture	0 (0.00)	0 (0.00)	1.000
Bleeding	2 (1.64)	3 (2.46)	1.000
Intrabdominal infection	4 (3.28)	4 (3.28)	1.000
Gastroparesis	1 (0.82)	1 (0.82)	1.000
Intestinal obstruction	2 (1.64)	3 (2.46)	1.000
Pneumonia	1 (0.82)	2 (1.64)	0.209
Pleural effusion	6 (4.92)	8 (6.56)	0.518
Respiratory failure	0 (0.00)	1 (0.82)	1.000
Clavien_Dindo classification			0.543
≤ Grade II	9 (7.38)	15 (12.30)
Grade IIIa/IIIb	8 (6.56)	10 (8.20)
Grade IVa/IVb	1 (0.82)	1 (0.82)
Grade V	104 (85.25)	95 (77.87)
Adjuvant chemotherapy			0.133
No	34 (27.9)	24 (19.7)
Yes	88 (72.1)	98 (80.3)

¹Values are presented as median (Q1-Q3).

PG: Proximal gastrectomy; TG: Total gastrectomy.

Table 4 Postoperative reflux assessment, n (%)

	TG (n = 122)	PG (n = 122)	P value
Reflux symptoms			0.017
No	84 (68.9)	100 (82.0)
Yes	38 (31.1)	22 (18.0)
Gerd-Q score			< 0.001
< 8	96 (78.7)	113 (92.6)
≥ 8	26 (21.3)	9 (7.4)
Reflux esophagitis (Los Angeles Classification)			< 0.001
No reflux	81 (66.4)	100 (82.0)
A	14 (11.5)	15 (12.3)
B	11 (9.0)	6 (4.9)
C	16 (9.0)	1 (0.8)

PG: Proximal gastrectomy; TG: Total gastrectomy; Gerd-Q: Gastroesophageal reflux disease questionnaire.

Table 5 Univariate Cox regression analysis for overall survival

Variables	Hazard ratio (95%CI)	P value
Group
PG	1.00 (Reference)
TG	1.15 (0.87-1.54)	0.330
Histological differentiation
Moderate/Well	1.00 (Reference)
Poor/others	3.60 (2.52-5.14)	< 0.001
Tumor size
> 4 cm	1.00 (Reference)
≤ 4 cm	0.18 (0.12-0.27)	< 0.001
Gender
Female	1.00 (Reference)
Male	0.88 (0.62-1.26)
Age
> 70	1.00 (Reference)
≤ 70	0.77 (0.53-1.13)
BMI
> 24 kg/m2	1.00 (Reference)
≤ 24 kg/m2	1.10 (0.83-1.47)
Clavien-Dindo Classification
> Grade II	1.00 (Reference)
≤ Grade II	0.68 (0.42-1.11)
TRG
> 1	1.00 (Reference)
≤ 1	0.95 (0.68-1.32)
NACT plus immunotherapy
No	1.00 (Reference)
Yes	0.71 (0.53-0.94)
NACT regimens
Others	1.00 (Reference)
SOX	0.97 (0.73-1.29)
NACT cycles
> 4	1.00 (Reference)
≤ 4	0.83 (0.56-1.25)
Vascular invasion
No	1.00 (Reference)
Yes	1.19 (0.87-1.63)
Perineural invasion
No	1.00 (Reference)
Yes	1.34 (1.00-1.81)
CR response
CR	1.00 (Reference)
Non-CR	1.25 (0.72-2.16)
Radical resection
R0	1.00 (Reference)
R1	0.81 (0.20-3.29)
ypT Stage
> T2	1.00 (Reference)
≤ T2	0.58 (0.43-0.79)
ypN Stage
> N0	1.00 (Reference)
N0	0.68 (0.48-0.96)

NACT: Neoadjuvant chemotherapy treatment; PG: Proximal gastrectomy; TG: Total gastrectomy; TRG: Tumor regression grade; CR: Complete response.