Can proximal gastrectomy be an alternative to total gastrectomy due to its nutritional advantage? A retrospective cohort study.

Purpose: This study aims to evaluate the outcomes of proximal gastrectomy (PG) compared to total gastrectomy (TG) in patients with proximal stomach cancer, focusing on nutritional advantages and overall survival.

Methods: A retrospective review was conducted on 87 patients who underwent gastrectomy for stomach cancer at Adnan Menderes University from January 2016 to January 2023. Among them, 21 patients underwent PG and 32 patients underwent TG. Clinical parameters, nutritional status, postoperative gastrointestinal symptoms, and survival rates were compared between the 2 groups. Statistical analyses included the chi-square test, Student t-test, and Mann-Whitney U-test.

Results: The PG group showed significantly less weight loss at 12 months (6.9 ± 5.2 kg vs. 17.9 ± 4.0 kg, P < 0.001) and higher albumin levels at both 6 and 12 months, postoperatively (P < 0.001). The reflux index was higher in the PG group (9.4 ± 2.4 vs. 5.2 ± 1.6, P < 0.001), but there was no significant difference in overall Gastrointestinal Symptom Rating Scale scores (P = 0.266). Disease-specific and overall survival were significantly better in the PG group (P = 0.004 and P = 0.003, respectively).

Conclusion: PG offers significant nutritional advantages and improved survival outcomes compared to TG despite higher rates of reflux. These findings suggest that PG can be a viable, function-preserving alternative to TG for patients with proximal stomach cancer. Further large-scale, prospective studies are needed to confirm these results and ensure oncological safety.