Application of two different gastrectomy methods in proximal gastric cancer

Abstract

Objective To evaluate the impacts of the two different gastrectomy methods on the quality of life, complication and prognosis in proximal gastric cancer. Methods One hundred and two cases of proximal gastric cancer in Tung Wah Hospital were collected for retrospective analysis. They were divided into proximal gastrectomy/gastroesophagostomy (PG) group (n=50) and total gastrectomy/esophagojejunostomy (TG) group (n=52), according to the methods of gastrectomy and reconstruction. The postoperative complications, nutritional status and prognosis of the two groups were compared. Results The incidence of reflux esophagitis was obviously higher in PG group than that in TG group (38.0% vs 19.2%, χ2=4.464, P=0.035). No significant differences were found between the two groups in the incidences of postoperative infection, bleeding and anastomotic leakage (χ2=0.063, P=1.000; χ2=0.001, P=0.978; χ2=0.311, P=0.577). There were no significant differences between PG and TG group in total plasma protein [(65.26±4.10)g/L vs (65.33±3.75)g/L, t=-0.402, P=0.688], albumin [(39.76±2.17)g/L vs (39.59±2.04)g/L, t=1.778, P=0.076], hemoglobin [(107.33±11.10)g/L vs (108.09±11.17)g/L, t=-1.502, P=0.133] and weight loss [1.00~8.00 kg vs 0.50~8.20 kg, t=-1.622, P=0.105] in one year postoperatively. All cases were followed-up for 7 months to 10 years. No significant differences were found between PG and TG group in the incidences of anastomotic tumor recurrence (4.0% vs 5.8%, χ2=0.171, P=0.679), metastasis (24.0% vs 28.8%, χ2=0.308, P=0.579) and median survival time (53.6 months vs 49.8 months, χ2=2.564, P=0.109). Conclusion Compared with PG group, the incidence of postoperative reflux esophagitis is effectively reduced, and the incidences of malnutrition, tumor recurrence and metastasis and death are not increased in TG group. Hence, TG should be a safe and effective surgery strategy. Key words: Stomach neoplasms; Postoperative complications; Prognosis; Nutritional status