Long-term nutritional status after total gastrectomy was comparable to proximal gastrectomy but with much less reflux esophagitis and anastomotic stenosis

Abstract

AimTo compare the long-term nutritional status, reflux esophagitis and anastomotic stenosis, between total gastrectomy (TG) and proximal gastrectomy (PG).MethodsPatients who underwent PG or TG in this single institution between January 2014 and December 2016 were included in this study. The inclusion and exclusion criteria were defined. One-to-one propensity score matching (PSM) by the demographic and pathological characteristics was performed to compare the long-term outcomes between the two groups. The primary endpoint was long-term nutritional status, and the second endpoints were reflux esophagitis and anastomotic stenosis. Long-term nutritional status was valued by percentage of body mass index (%BMI), body weight, and blood test including total protein, prealbumin, hemoglobin and total leukocytes.ResultsTotally 460 patients received PG or TG in our institution for the treatment between January 2014 and December 2016 and according to the inclusion and exclusion criteria 226 cases were included in this study finally. There was no significant difference as to nutritional status in the end of first 5 years after PG or TG. While reflux esophagitis and anastomotic stenosis were significantly higher in the PG group than in the TG group (54.4% versus 26.8%, p < 0.001; 14.9% versus 4.5%, p=0.015; respectively). Overall survival rates were similar between the two groups after PSM (5-year survival rates: 65.4% versus 61.5% in the PG and TG groups, respectively; p = 0.54). The rate of carcinoma of remnant stomach after PG was 3.5% in this group of patients.ConclusionsTG should be more aggressively recommended for the similar nutritional status, significantly lower reflux esophagitis and anastomotic stenosis, and free of carcinoma of remnant stomach compared with PG.

An improvement in the reconstruction of digestive tract after total gastrectomy: ultra-short cecum

“…An early study showed that 20.90% of patients had reflux esophagitis under endoscopy despite undergoing Roux-en-Y anastomosis after TG, among whom 77.78% had Los Angeles (LA) grade C esophagitis and 5.43% of patients had concurrent reflux esophagitis and Barrett’s esophagus, which significantly affected their quality of life ( 6 ). Additionally, our previous study on esophagogastric junctional gastric cancer also indicated that 26.8% of patients developed reflux esophagitis within 5 years after TG with Roux-en-Y reconstruction ( 8 ).…”

“…According to the latest Japanese gastric cancer treatment guidelines, the standard surgical procedure for clinically node-positive (cN +) or T2–T4a tumors is either total or distal gastrectomy ( 5 ). Among all the gastric cancer patients who received surgical resection nearly 40% underwent total gastrectomy and what’s more about 15%~30% of the patients will have sever reflux after TG ( 6 – 8 ), and about 12.3% of patients have poor quality of life due to reflux and some of them need to be readmitted to the hospital for treatment ( 9 ).…”

Comparing the outcomes of laparoscopic proximal and laparoscopic total gastrectomy: A retrospective analysis of a single center in Japan

“…The benefit of PG on postoperative body weight also remains to be established. The main conclusion of previous studies was that PG alleviates postoperative body weight loss compared to that after TG, 10,12,15,25 whereas other studies reported no difference between PG and TG 20,26–28 . In Japan, a nationwide survey using a questionnaire was conducted to evaluate postoperative symptoms after gastrectomy, and the results reported superiority of PG on postoperative body weight for upper stomach cancer 29 but not for esophagogastric junctional cancer 30 …”

“…The main conclusion of previous studies was that PG alleviates postoperative body weight loss compared to that after TG, 10,12,15,25 whereas other studies reported no difference between PG and TG. 20,[26][27][28] In Japan, a nationwide survey using a questionnaire was conducted to evaluate postoperative symptoms after gastrectomy, and the results reported superiority of PG on postoperative body weight for upper stomach cancer 29 but not for esophagogastric junctional cancer. 30 As the safety of laparoscopic gastrectomy for PGC was established by a nationwide prospective study in Japan, 31 laparoscopic proximal gastrectomy (LPG) has been widely performed.…”