Journal ArticleDOI
Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary
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TLDR
PG should be an alternative to TG, even in locally advanced proximal gastric cancers treated by NACT, provided that the tumor size and location permit preservation of adequate remnant of stomach without compromising oncological resection margins.Abstract:
The appropriate extent of gastric resection for patients with proximal third gastric cancer is controversial. This study addresses whether the choice of surgical strategy (proximal gastrectomy [PG] versus total gastrectomy [TG]) influences the outcomes for proximal third gastric adenocarcinoma. Review of prospective database at Tata Memorial Hospital from January 2010 to December 2012 identified 343 patients diagnosed and treated for gastric cancer. Of these, 75 underwent curative resections with D2 lymphadenectomy for proximal third gastric adenocarcinoma, which entailed proximal gastrectomy in 43 and total gastrectomy in 32 patients, depending on the epicenter of the primary and its relation with the mid-body of the stomach. Morbidity, lymph node yield, resection margins, patterns of recurrence, and survival were compared between these two groups. 41/75 tumors were pT3 (23 cases [53.4 %] in the PG and 18 cases [56.3 %] in the TG group). Thirty-six patients [83.7 %] in PG and 29 patients [90.6 %] in TG group received neoadjuvant chemotherapy (NACT). There were no significant differences with regard to median blood loss, general complication rates and length of hospitalization between the two groups. The lymph node yield was comparable between the two procedures [PG = 14; TG = 15]. Positive proximal resection margin rates were comparable between the two groups [PG = 4.7 %; TG = 9.4 %], and there was no statistical difference observed in the distal resection margin positivity rates [PG = 4.7 %; TG = 3.1 %]. Regarding the patterns of recurrence, local recurrence in PG was 4.7 % and there was no local recurrence in the TG group (p = 0.08). Distant recurrence rates was dominant in TG [PG = 30.2 % versus TG = 53.1 %]. The overall 2-year survival following PG and TG was 73.8 and 49.9 %, respectively, and not statistically different (p = 0.10). The extent of resection for proximal third gastric cancer does not influence the clinical outcome. PG and TG have similar survival rates. Both procedures can be accomplished safely. Therefore, PG should be an alternative to TG, even in locally advanced proximal gastric cancers treated by NACT, provided that the tumor size and location permit preservation of adequate remnant of stomach without compromising oncological resection margins. Future QOL studies would further lend credence to the concept of PG for proximal third gastric cancer.read more
Citations
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Journal ArticleDOI
Clinical Outcomes of Proximal Gastrectomy versus Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta-Analysis.
Lulu Zhao,Rui Ling,Jinghua Chen,Anchen Shi,Changpeng Chai,Fuhai Ma,Dongbing Zhao,Yingtai Chen +7 more
TL;DR: PG was associated with a visible improved long-term survival outcome for all irrespective of tumor stage, while a similar 5-year OS for only early gastric cancer patients between the 2 groups.
Journal ArticleDOI
Proximal Gastrectomy versus Total Gastrectomy for Siewert Type II Adenocarcinoma of the Esophagogastric Junction: A Comprehensive Analysis of Data from the SEER Registry
Kaixuan Zhu,Yingying Xu,Jiaxin Fu,Farah Abdidahir Mohamud,Zongkui Duan,Siyuan Tan,Zekun Zhao,Ping Chen,Liang Zong +8 more
TL;DR: PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG, and for elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.
Journal ArticleDOI
Precision surgical approach with lymph-node dissection in early gastric cancer.
Shinichi Kinami,Naohiko Nakamura,Yasuto Tomita,Takashi Miyata,Hideto Fujita,Nobuhiko Ueda,Takeo Kosaka +6 more
TL;DR: Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.
Journal ArticleDOI
Surgical Management of Gastric Cancer: A Systematic Review
TL;DR: A review of the current standards in the surgical treatment of gastric cancer can be found in this article, where the authors summarize the standardization of surgical treatment in accordance with the patient's profile for a better outcome.
Journal ArticleDOI
Intraoperative blood loss does not independently affect the survival outcome of gastric cancer patients who underwent curative resection.
TL;DR: The tumor located in upper 1/3 stomach, total gastrectomy, combined organ resection and advanced tumor stage (stage III) were independent risk factors for intraoperative massive hemorrhage.
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TL;DR: The incidence of gastric cancer varies widely by country and population, with higher rates among the lower socioeconomic groups as discussed by the authors, although rates have generally decreased, there has been a dramatic increase in the incidence of Gastric cancer in the cardia.