Abstract

Background/Aim: The theoretical functional advantages of proximal resection with jejunal interposition could outweigh the higher risk of recurrence in the unfit elderly population. The aim of our study was to evaluate proximal resection as an alternative in selected patients.

Methods: Between 1993 and 2009, 161 patients were operated on in our centre for adenocarcinoma of the proximal third of the stomach. They were divided into three groups: PG: proximal resection with jejunal interposition; TH: transhiatal extended total gastrectomy; GT: total gastrectomy. We analysed the postoperative morbidity, 30-day mortality, survival, and quality of life with a questionnaire.

Results: The patients in the PG group were significantly older and in worse general condition. The number of harvested lymph nodes was significantly smaller than in the GT and TH groups. There were no significant differences in the distribution of TNM stages between groups. There were no differences in the morbidity and 5-year survival rates between groups. No differences were found in the total scores of the GIQLI questionnaire.

Conclusion: Proximal resection should be reserved only for high-risk elderly population with proximal gastric cancer. These resections carry acceptable morbidity and mortality; however, the reconstruction with jejunal interposition does not bring the desired functional benefits.

Keywords: Gastric Adenocarcinoma; Proximal Resection; Jejunal Interposition; Quality of Life

References

1. Shiriashi N., et al. “Clinical Outcome of Proximal versus Total Gastrectomy for Proximal Gastric Cancer”. World Journal of Surgery 26 (2002): 1150-1154.
2. Adachi Y., et al. “Proximal Gastrectomy and Gastric Tube Reconstruction for Early Cancer of the Gastric Cardia”. Digestive Surgery 16 (1999): 468-470.
3. Takeshita K., et al. “Proximal gastrectomy and jejunal pouch interposition for the treatment of early cancer in the upper third of the stomach: Surgical techiques and evaluation of postoperative function”. Surgery 121.3 (1997): 278-286.
4. Siewert JR., et al. “Adenocarcinoma of the Esophagogastric Junction. Results of Surgical Therapy Based on Anatomical/Topographic Classification in 1002 Consecutive Patients”. Annals of Surgery 232(3) (2000): 353-361.
5. Kameyama J., et al. “Proximal gastrectomy reconstructed by interposition of a jejunal pouch: surgical technique”. European Journal of Surgery 159 (1993): 491-493.
6. Eypash E., et al. “Gastrointestinal Quality of Life Index: developement, validation and application of a new instrument”. British Journal of Surgery 82 (1995): 216-222.
7. Gockel I., et al. “Lebensqualität nach subtotaler Magenresekcion und Gastrektomie beim Magenkarcinom”. Chirurg 76 (2005): 250-257.
8. Wilson TR and Alexander DJ. “Clinical and non-clinical factors influencing postoperative health-related quality of life in patients with colorectal cancer”. British Journal of Surgery 95 (2008): 1408-1415.
9. Di Martino N., et al. “Adenocarcinoma of gastric cardia in the elderly: Surgical problems and prognostic factors”. World Journal of Gastroenterology 11.33 (2005): 5123-5128.
10. Ichikura T., et al. “Is adenocarcinoma of the gastric cardia a distinct entity indipendent of subcardial carcinoma?” World Journal of Surgery 27 (2003): 334-338.
11. Mariette C., et al. “Surgical management of long-term survival after adenocarcinoma of the cardia”. World Journal of Surgery 89 (2002): 1156-1163.
12. Nomura E., et al. “Postoperative Evaluation of the Jejunal Pouch Reconstruction Following Proximal and Distal Gastrectomy for Cancer”. Hepato-Gastroenterology 51 (2004): 1561-1566.
13. Kitamura K., et al. “The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach”. Japan Journal of Surgery 27 (1997): 993-998.
14. Katsoulis IE., et al. “What Is the Difference between Proximal and Total Gastrectomy Regardind Postoperative Bile Reflux into Oesophagus?” Digestive Surgery 23 (2006): 325-330. 
15. Peto R and Peto J. “Asymptotically efficient rank invariant test procedures”. The Journal of Royal Statistical Society 34 (1972): 205-207. 
16. Breslow NE. “Covariance analysis of censored survival data”. Biometrics 30 (1974): 89-99.
17. Tarone RE and Ware J. “On distribution-free tests for equality of survival distributions”. Biometrika 64 (1977): 165-260.
18. Lee ET., et al. “A Monte-Carlo study of the power of some two-sample tests”. Biometrika 62 (1975): 425-432.
19. Prentice RL and Marek P. “A qualitative discrepancy between censored data rank test”. Biometrics 35 (1979): 861-867.
20. RD. “Censoring and stochastic integrals”. Mathematical Centre Tracts (1980): 124.
21. Klein J and Moeschberger M. “Survival analysis, techniques for censored and truncated data”. Springer Berlin (1998).
22. Hosmer DW and Lemeshow S. “Applied survival analysis”. Wiley: New York (1999).
23. Xun L and Qiang X. “A new method for the comparison of survival distributions”. Pharmaceutical Statistics 9 (2010): 67-76.
24. DeVitta VT., et al. “Adverse Effects of Treatments”. Cancer-principles and Practice of Oncology (2005): 2515-615.
25. Clavien PA., et al. “The Clavien-Dindo classification of surgical complications: five-year experience”. Annuals of Surgery 250 (2009): 187-196.

Citation

Citation: Jagric Tomaz and Jagric Timotej. “Is the Proximal Subtotal Gastrectomy a Better Choice in Selected Patients than Radical Gastrectomy: A Comparison of Morbidity, Mortality and Survival after Surgical Treatment of Proximal Third Gastric Adenocarcinoma”. Acta Scientific Gastrointestinal Disorders 3.9 (2020): 21-29.

Copyright

Copyright: © 2020 Jagric Tomaz and Jagric Timotej. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.