Proximal gastrectomy OK for proximal advanced gastric cancer

For patients with proximal advanced gastric cancer (AGC), proximal gastrectomy (PG) appears to be a reasonable treatment option, particularly for those with small tumours, a recent study has found.

The study included 329 patients scheduled for surgery for proximal AGC. Most of the participants (n=254) received total gastrectomy, while 75 underwent PG. After propensity score matching, 67 patients remained in each surgery subgroup, which was statistically balanced in terms of baseline factors.

Five-year overall survival was 74.9 percent in PG patients, as opposed to 64.3 percent in those who received total gastrectomy. The difference was nominal and failed to reach significance (p=0.275). Stage-specific survival was likewise comparable between groups, though those with TNM stage III had better survival after PG vs total gastrectomy before matching (p=0.024).

Procedurally, both PG and total gastrectomy had similar operation times (p=0.429) and resulted in comparable blood loss volumes (p=0.793). Median postoperative stay, however, was significantly lower in the PG group (median, 12 vs 14 days; p=0.003).

Multivariate Cox regression analysis revealed that tumour diameter >4 cm was a significant risk factor for death in AGC patients (hazard ratio [HR], 1.917, 95 percent confidence interval [CI], 1.188–3.094; p=0.008) as was the presence of lymph node metastasis (HR, 1.944, 95 percent CI, 1.171–3.230; p=0.01).

The use of PG vs TG was only borderline protective against death (HR, 0.523, 95 percent CI, 0.254–1.076; p=0.078).