Short- and Mid-Term Outcomes of Proximal Gastrectomy With Double-Tract Reconstruction Versus Total Gastrectomy in Early-Stage Proximal Gastric Cancer

IF 3.1 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-09-17 DOI:10.1002/cam4.71258

Ying Liu, Mingfang Yan, Zhaoyan Lin, Shenghong Wei, Yangming Li, Zhenmeng Lin, Xingfa Chen

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Abstract

Background

Total gastrectomy (TG) is the predominant approach for proximal gastric cancer; however, it frequently leads to various postoperative nutritional and metabolic disorders. Recently, double-tract reconstruction (DTR) following proximal gastrectomy (PG) has been developed to preserve gastric function and reduce postoperative reflux esophagitis. This study aimed to compare the outcomes of PG-DTR with those of TG in patients with proximal gastric cancer.

Methods

Patients with clinically staged cT1 to cT2 proximal gastric cancer who underwent either PG-DTR or TG with Roux-en-Y reconstruction (TG-RY) were enrolled. Propensity score matching (PSM) was applied to reduce confounding bias. Surgical outcomes, nutritional status, reflux esophagitis, and prognosis were prospectively analyzed. Quality of life (QOL) was assessed at 3, 6, and 12 months postoperatively using the Postgastrectomy Syndrome Assessment Scale-45 (PGSAS-45).

Results

After PSM, 93 patients were included in each group (PG-DTR and TG-RY). The PG-DTR group had fewer retrieved lymph nodes than the TG-RY group. No significant differences were observed between the groups in operative time, blood loss, postoperative complications, length of hospital stay, reflux esophagitis, overall survival (OS), or disease-free survival (DFS). Female sex, preoperative BMI, TG-RY procedure, and severe postoperative complications (POCs) were identified as independent risk factors for malnutrition at 3 months postgastrectomy. Postoperatively, the TG-RY group exhibited significantly lower levels of hemoglobin, total protein, and albumin than the PG-DTR group. No differences were observed in postoperative QOL between the two groups, except for greater weight loss in the TG-RY group.

Conclusions

Compared to TG-RY, PG-DTR was associated with improved postoperative nutritional status, including better body weight, hemoglobin, and albumin levels, in patients with early-stage proximal gastric cancer. Additionally, PG-DTR demonstrated comparable short-term outcomes, prognosis, and postoperative QOL to TG-RY, further supporting its viability as a surgical option.

Abstract Image

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早期近端胃癌双胃道重建与全胃切除术的中短期疗效比较。

背景：全胃切除术（TG）是治疗近端胃癌的主要方法；然而，它经常导致各种术后营养和代谢紊乱。最近，近端胃切除术（PG）后的双道重建（DTR）已被开发用于保护胃功能和减少术后反流性食管炎。本研究旨在比较PG-DTR与TG在近端胃癌患者中的疗效。方法：入选临床分期为cT1 ~ cT2期的胃癌近端癌患者，行PG-DTR或TG合并Roux-en-Y重建（TG- ry）。采用倾向评分匹配（PSM）来减少混杂偏倚。前瞻性分析手术结果、营养状况、反流性食管炎和预后。使用胃切除术后综合征评估量表-45 （PGSAS-45）评估术后3、6和12个月的生活质量（QOL）。结果：经PSM治疗后，PG-DTR组和TG-RY组各纳入93例患者。PG-DTR组比TG-RY组有更少的淋巴结。两组在手术时间、出血量、术后并发症、住院时间、反流性食管炎、总生存期（OS）或无病生存期（DFS）方面均无显著差异。女性、术前BMI、TG-RY手术和术后严重并发症（POCs）被确定为胃切除术后3个月营养不良的独立危险因素。术后TG-RY组血红蛋白、总蛋白和白蛋白水平明显低于PG-DTR组。两组术后生活质量无差异，除了TG-RY组体重下降更大。结论：与TG-RY相比，PG-DTR与早期近端胃癌患者术后营养状况改善相关，包括更好的体重、血红蛋白和白蛋白水平。此外，PG-DTR表现出与TG-RY相当的短期预后、预后和术后生活质量，进一步支持其作为手术选择的可行性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.