Oncological feasibility of laparoscopic subtotal gastrectomy compared with laparoscopic proximal or total gastrectomy for cT1N0M0 gastric cancer in the upper gastric body

Abstract

Background The upper gastric body is of particular interest in relation to gastrectomy because this area includes a border; that is, both distal and proximal gastrectomy for early gastric cancer can involve this area. Laparoscopic subtotal gastrectomy (LsTG) is reported to be suitable procedure compared with laparoscopic proximal and total gastrectomy (LPG, LTG), regarding postoperative nutritional status and surgical safety. However, whether LsTG is an oncologically acceptable procedure for early gastric cancer in the upper gastric body is unclear. Methods We analyzed 215 patients with cT1N0M0 gastric cancer limitedly located in the upper gastric body. The frequency of conversion from each intended procedure to an alternative procedure, the width of the pathological margin, the incidence of lymph node metastasis at each station and the 3-year overall survival (OS) and relapse-free survival (RFS) were evaluated. Results LsTG was planned for 65 patients, and LPG for 72 and LTG for 78, respectively. Conversion to other procedures was required in about 10% of patients for whom LsTG or LPG was planned. The width of the pathological margin in patients who underwent LsTG was significantly shorter than patients who underwent the others. No patients who underwent LsTG, LPG or LTG had metastases in station no. 2 or 4sa lymph node. The 3-year OS and RFS rates of patients for whom each procedure was planned were not different. Conclusions LsTG could be an oncologically acceptable procedure for cT1N0M0 gastric cancer in the upper gastric body. LsTG could be one option for such disease.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Laparoscopic proximal gastrectomy with double-flap technique versus laparoscopic subtotal gastrectomy for proximal early gastric cancer

“…This minimizes subsequent reflux oesophagitis, which may influence food intake, bodyweight, haemoglobin concentration and nutritional status. With previously reported comparable survival, LPG‐DFT may be superior to LSTG.…”

Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

“…Five homogenous ( I 2 = 39%, P = 0.16) studies (690 patients) reported 5-year overall survival rates ( 31 , 34 – 36 , 41 ). The results revealed that patients who had undergone LTG or LPG had similar 5-year overall survival rates (OR = 1.04, 95% CI: 0.47 to 2.27, P = 0.93, Figure 4A ).…”

Postoperative nutritional outcomes and quality of life-related complications of proximal versus total gastrectomy for upper-third early gastric cancer: a meta-analysis

“…To overcome the limitations of EG like symptomatic reflux, several additional anti-reflux techniques have been designed, such as the double flap technique (DFT) during EG with valvuloplasty, in which a seromuscular flap is created to avoid reflux 18,19 . In a previous retrospective study performed by Hayami et al, anastomotic complications (4.7% vs. 17.2%) and severe reflux esophagitis with LA grade ≥ B (2.3% vs. 14.9%) occurred less frequently after EG with DFT than after TG, but the difference was not significant (p = 0.093 and p = 0.06, respectively) 19 .…”

“…In a previous retrospective study performed by Hayami et al, anastomotic complications (4.7% vs. 17.2%) and severe reflux esophagitis with LA grade ≥ B (2.3% vs. 14.9%) occurred less frequently after EG with DFT than after TG, but the difference was not significant (p = 0.093 and p = 0.06, respectively) 19 . Although EG with DFT was excluded from the present meta-analysis because of insufficient data and the heterogeneity of EG combined with DFT due to EG in operative and reflux-related outcomes, the efficacy and safety of this technique should also be evaluated by comparing EG with DFT and other methods in future studies 18,19,65 .…”