P15 Morbidity, mortality, and survival of patients with proximal gastric adenocarcinoma after proximal subtotal gastrectomy – A comparative study

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Background: The advantages of proximal resection with jejunal interposition and modified D2 lymphadenectomy, for elderly patients, could outweigh the higher risk of recurrence with this less radical lymphadenectomy. The aim of our study was to evaluate proximal resection with modified D2 lymphadenectomy as an alternative in selected patients. Methods: Between 1993 and 2009, 161 patients at our centre had surgery for adenocarcinoma of the proximal third of the stomach. Patients were divided into three groups: (1) PG, proximal resection with jejunal interposition and modified D2 lymphadenectomy (19.3%, 31 patients); (2) TH, transhiatal extended total gastrectomy with resection of the distal oesophagus and D2 lymphadenectomy (23.6%, 38 patients); (3) GT, total gastrectomy with D2 lymphadenectomy (57.1%, 92 patients). We analysed postoperative morbidity, 30-day mortality, and survival. Quality of life was evaluated with the gastrointestinal quality-of-life index (GIQLI) questionnaire. Findings: Patients in the PG group (79.4 ± 9 years) were significantly older than the patients in the GT (63.9 ± 11 years) or TH group (60.1 ± 12 years; p < 0.0001), and in worse general condition. Fewer lymph nodes were harvested in the PG group (17.2 ± 11) than in the GT and TH groups (24.05 ± 13 and 26.3 ± 13). There were no significant differences in the distribution of pathohistological characteristics and tumour TNM stages between groups. An R0 resection could be done in 77.2–86.8% of cases. 30-day mortality was 9.7% in the PG group, 6.5% in GT, and 5.3% in TH. There were no differences in morbidity and 5-year survival between groups (25.3% in PG, 26.3% in GT, and 28.9% in TH). No differences were found in the total scores of the GIQLI questionnaire (p = 0.893). Patients in the PG group had the lowest scores in digestive functions. Interpretation: Proximal resection should be reserved for highrisk elderly patients with proximal gastric cancer, who have shorter expected long-term survival. These resections carry acceptable morbidity and mortality; however, reconstruction with jejunal interposition does not bring the desired functional benefits. Funding: None. The authors declared no conflicts of interest.