PARTIAL GASTRECTOMY FOR EARLY PROXIMAL GASTRIC CANCER

NEW YORK (Reuters Health) - Patients undergoing proximal gastrectomy (PG) for proximal early gastric cancer (EGC) appear to fare as well as those treated with total gastrectomy (TG), according to researchers from South Korea.

Many previous studies have compared the two procedures, but still no consensus exists about which is better, Dr. Moon Soo Lee, of Soonchunhyang University Hospital Cheonan, and colleagues say.

"Although PG has an advantage over TG in that the lower part of the stomach can be preserved with PG, it is rarely chosen because of the possibility of severe postoperative gastroesophageal reflux and the higher risk of cancer recurrence with PG than with TG," they wrote in the Journal of Gastric Cancer, online December 26.

Their study included 64 patients who underwent PG performed with esophagogastrostomy using a circular stapler after pyloroplasty using Hegar's dilator, and 106 patients who had undergone TG with uncut Roux-en-y esophagojejunostomy.

Tumors were larger, and more lymph nodes were retrieved, in the TG group. But the number of metastatic perigastric nodes and the incidence of positive nodes were similar in the two groups.

The postoperative complication rate came to 17% in the PG group and 11% in the TG group, but the difference was not statistically significant. Severe reflux esophagitis, defined as Los Angeles grade C or D reflux esophagitis, occurred in 9% and 23% of the patients, respectively (p=0.028).

Patients undergoing PG had a five-year survival rate of 95.6%, similar to the 95.3% in the TG group. There were no recurrences, including remnant gastric cancer, in the PG group.

Weight loss was significantly more pronounced in the TG group, and levels of hemoglobin, albumin and vitamin B12 were significantly lower at various follow-up assessments in this group.

The researchers say selection bias may have influenced their findings. Still, they conclude, "PG can be considered as an effective surgical treatment" for proximal early gastric cancer.

The authors reported no disclosures or funding.