Indications and technical aspects of proximal gastrectomy

Abstract

According to the World Health Organization, gastric cancer is the fifth most common type of tumor, and is the third most common cause of tumor-associated death. Although gastric cancer incidence rates have decreased in the past few decades, the prevalence of proximal gastric cancer has been steadily rising in developed countries. Techniques regarding the improvement of treatment options must thus be developed. This can be achieved through incorporating both a wider use of endoscopic surgery (endoscopic mucosal resection—EMR, endoscopic submucosal dissection—ESD) and a review of applied surgical interventions. Even though there is no single international consensus available, the Japanese Gastric Cancer Association (JGCA) recommends proximal gastrectomy with D1+ lymphadenectomy in early gastric tumors. Despite recommendations from Asian guidelines and the short term outcomes of the KLASS 05 trial, surgical treatments in Western countries still rely on total gastrectomy. This is mostly due to technical and oncological challenges regarding surgical interventions in a proximal gastrectomy. However, the residual stomach after a proximal gastrectomy has been shown to diminish the incidence of dumping syndrome and anemia, and even improve postoperative quality of life (QoL). Therefore, it is necessary to define the place of proximal gastrectomy in the treatment of gastric cancers.

A multi‐institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602)

“…26 Furthermore, several retrospective studies show that PG is superior to TG in maintaining body weight and preserving QOL. 6,27 For example, Takiguchi, et al compared postoperative QOL between TG (n = 393) and PG (n = 193) and found that PG achieved better QOL with less diarrhea and dumping symptoms, less weight loss, and less necessity for additional meals. 23 Nakada, et al reported that PG compared with TG was associated with diminished adverse effects on QOL, as assessed using a PGSAS questionnaire, resulting in less impairment of daily living.…”

“…Furthermore, several retrospective studies show that PG is superior to TG in maintaining body weight and preserving QOL. 6,27 For example, Takiguchi, et al. compared postoperative QOL between TG ( n = 393) and PG ( n = 193) and found that PG achieved better QOL with less diarrhea and dumping symptoms, less weight loss, and less necessity for additional meals 23 .…”

“…For example, TG may achieve adequate resection margins and radical lymph node dissection; however, it is accompanied by poor postoperative nutritional status, characterized by anemia and weight loss 1,3,4 . PG may improve the postsurgical nutritional status and quality of life (QOL) of patients because of the preserved remnant stomach, which stores food and promotes the absorption of iron, vitamin B12, and other nutrients 5,6 . However, in addition to the risk of remnant cancer, PG raises concerns that the presence of a residual stomach may reduce QOL because of acid reflux esophagitis 7 .…”

“…1,3,4 PG may improve the postsurgical nutritional status and quality of life (QOL) of patients because of the preserved remnant stomach, which stores food and promotes the absorption of iron, vitamin B12, and other nutrients. 5,6 However, in addition to the risk of remnant cancer, PG raises concerns that the presence of a residual stomach may reduce QOL because of acid reflux esophagitis. 7 Thus, the clear advantages gained by improving postoperative QOL must be demonstrated to qualify PG as standard procedure.…”