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Gastrointestinal cancer
Proximal Gastrectomy Is Associated with Lower Incidence of Anemia and Vitamin B12 Deficiency Compared to Total Gastrectomy in Patients with Upper Gastric Cancer
Jeong Ho Song, Sung Hyun Park, Minah Cho, Yoo Min Kim, Woo Jin Hyung, Hyoung-Il Kim
Cancer Res Treat. 2025;57(1):174-185.   Published online July 3, 2024
DOI: https://doi.org/10.4143/crt.2024.319
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Proximal gastrectomy is an alternative to total gastrectomy (TG) for early gastric cancer (EGC) treatment in the upper stomach. However, its benefits in terms of perioperative and long-term outcomes remain controversial. The aim of this study was to compare the perioperative, body compositional, nutritional, and survival outcomes of patients undergoing proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG for pathological stage I gastric cancer in upper stomach.
Materials and Methods
The study included 506 patients who underwent gastrectomy for pathological stage I gastric cancer in the upper stomach between 2015 and 2019. Clinicopathological, perioperative, body compositional, nutritional, and survival outcomes were compared between the PG-DTR and TG groups.
Results
The PG-DTR and TG groups included 197 (38.9%) and 309 (61.1%) patients, respectively. The PG-DTR group had a lower rate of early complications (p=0.041), lower diagnosis rate of anemia and vitamin B12 deficiency (all p < 0.001), and lower replacement rate of iron and vitamin B12 compared to TG group (all p < 0.001). The PG-DTR group showed reduced incidence of sarcopenia at 6-months postoperatively, preserved higher amount of visceral fat after surgery (p=0.032 and p=0.040, respectively), and showed a higher hemoglobin level (p=0.007). Oncologic outcomes were comparable between the groups.
Conclusion
The PG-DTR for EGC located in the upper stomach offered advantages of fewer complications, lower incidence of anemia and vitamin B12 deficiency, less decrease in visceral fat volume, and similar survival compared to TG. Consequently, PG-DTR may be considered a superior alternative treatment option to TG.

Citations

Citations to this article as recorded by  
  • Proximal Gastrectomy for Upper-third Early Gastric Cancer
    Guanhong Min, Kwangyong Kim, Seonghoon Cho, Jaewoo Shim
    Journal of Digestive Cancer Research.2024; 12(2): 68.     CrossRef
  • 1,366 View
  • 95 Download
  • 1 Crossref
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Gastrointestinal Cancer
Double Tract Reconstruction Reduces Reflux Esophagitis and Improves Quality of Life after Radical Proximal Gastrectomy for Patients with Upper Gastric or Esophagogastric Adenocarcinoma
Xin Ji, Chenggen Jin, Ke Ji, Ji Zhang, Xiaojiang Wu, Ziyu Jia, Zhaode Bu, Jiafu Ji
Cancer Res Treat. 2021;53(3):784-794.   Published online December 29, 2020
DOI: https://doi.org/10.4143/crt.2020.1064
AbstractAbstract PDFPubReaderePub
Purpose
The aim of the present study was to compare the difference between double tract reconstruction and esophagogastrostomy.
Materials and Methods
Patients who underwent radical proximal gastrectomy with esophagogastrostomy or double tract reconstruction were included in this study.
Results
Sixty-four patients were included in this study and divided into two groups according to reconstruction method. The two groups were well balanced in perioperative safety and 3-year overall survival (OS). The rates of postoperative reflux esophagitis in the double tract reconstruction group and esophagogastrostomy group were 8.0% and 30.8%, respectively (p=0.032). Patients in the double tract reconstruction group had a better global health status (p < 0.001) and emotional functioning (p < 0.001), and complained less about nausea and vomiting (p < 0.001), pain (p=0.039), insomnia (p=0.003), and appetite loss (p < 0.001) based on the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire. Regarding the EORTC QLQ-STO22 questionnaire, patients in the double tract reconstruction group complained less about dysphagia (p=0.030), pain (p=0.008), reflux (p < 0.001), eating (p < 0.001), anxiety (p < 0.001), dry mouth (p=0.007), and taste (p=0.001). The multiple linear regression analysis showed that reconstruction method, postoperative complications, reflux esophagitis, and operation duration had a linear relationship with the global health status score.
Conclusion
Double tract reconstruction could better prevent reflux esophagitis and improve quality of life without scarifying perioperative safety or 3-year OS.

Citations

Citations to this article as recorded by  
  • Function Preserving Gastrectomy and Quality of Life
    Jeesun Kim, Hyuk-Joon Lee
    Journal of Gastric Cancer.2025; 25(1): 247.     CrossRef
  • Comparative study of clinical efficacy of laparoscopic proximal gastrectomy with double-channel anastomosis and tubular gastroesophageal anastomosis
    Mian Wang, Li-Li Zhang, Gang Wang, Yong-Chang Miao, Tao Zhang, Lei Qiu, Gui-Da Fang, Feng Lu, Da-Lai Xu, Peng Yu
    World Journal of Gastrointestinal Surgery.2025;[Epub]     CrossRef
  • Comparison of the efficacy, safety and postoperative quality of life between modified side overlap anastomosis and double-tract anastomosis after laparoscopic proximal gastrectomy
    Chu-Ying Wu, Wen-Jin Zhong, Kai Ye
    Updates in Surgery.2024; 76(6): 2255.     CrossRef
  • Study of Short-Term and Long-Term Outcomes Between Esophagogastrostomy and Double-Tract Reconstruction After Proximal Gastrectomy
    Tsuyoshi Hasegawa, Naoshi Kubo, Katsunobu Sakurai, Junya Nishimura, Yasuhito Iseki, Takafumi Nishii, Sadatoshi Shimizu, Toru Inoue, Yukio Nishiguchi, Kiyoshi Maeda
    Journal of Gastrointestinal Cancer.2024; 55(3): 1089.     CrossRef
  • Comparative analysis of two digestive tract reconstruction methods in total laparoscopic radical total gastrectomy
    Tian-Xiang Dong, Dong Wang, Qun Zhao, Zhi-Dong Zhang, Xue-Feng Zhao, Bi-Bo Tan, Yu Liu, Qing-Wei Liu, Pei-Gang Yang, Ping-An Ding, Tao Zheng, Yong Li, Zi-Jing Liu
    World Journal of Gastrointestinal Surgery.2024; 16(4): 1109.     CrossRef
  • Differences in glycemic trends due to reconstruction methods after proximal gastrectomy from the perspective of continuous glucose-monitoring
    Katsutoshi Shoda, Takeshi Kubota, Yoshihiko Kawaguchi, Hidenori Akaike, Suguru Maruyama, Yudai Higuchi, Takashi Nakayama, Ryo Saito, Koichi Takiguchi, Shinji Furuya, Kensuke Shiraishi, Hidetake Amemiya, Hiromichi Kawaida, Daisuke Ichikawa
    Surgery Today.2024; 54(9): 1104.     CrossRef
  • The Short‐Term and Long‐Term Outcomes of Laparoscopy‐Assisted Proximal Gastrectomy with Double‐Tract Reconstruction versus Laparoscopy‐Assisted Total Gastrectomy with Roux‐en‐Y Reconstruction for Adenocarcinoma of the Esophagogastric Junction: A Multicent
    Zhiwen Xu, Wei Lin, Su Yan, Shaoqin Chen, Jinping Chen, Qingqi Hong, Hexin Lin, Liangbin Xiao, Jingtao Zhu, Haoyu Bai, Xuejun Yu, Jun You, Eiji Sakai
    Gastroenterology Research and Practice.2024;[Epub]     CrossRef
  • Double tract reconstruction improves the quality of life and better maintain the BMI of patients with proximal gastric cancer
    Zi jian Wang, Zi yao Xu, Zi jie Huang, Li Li, Da Guan, Yun he Gao, Xin xin Wang
    BMC Surgery.2024;[Epub]     CrossRef
  • Short-term outcomes and quality of life of esophagogastrostomy versus the double-tract reconstruction after laparoscopic proximal gastrectomy
    Yong Sun, Chao Chen, Lei Hou, Enhong Zhao
    BMC Cancer.2024;[Epub]     CrossRef
  • Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach: An innovative method of digestive tract reconstruction following proximal gastrectomy
    JiaQing Gong, Xia Liu, GuangLan Wang, Wei Li, GuoDe Luo, Yan Lin, Bin Zhang, ChuanDong Chen
    Asian Journal of Surgery.2023; 46(10): 4196.     CrossRef
  • Safety and efficacy of laparoscopic proximal gastrectomy with SOFY versus laparoscopic total gastrectomy with Roux-en-Y for treating cT1-2 Siewert II/III adenocarcinoma of the esophagogastric junction: a single-center prospective cohort study
    Haiqiao Zhang, Zhi Zheng, Xiaoye Liu, Chenglin Xin, Yong Huang, Yuan Li, Jie Yin, Jun Zhang
    Langenbeck's Archives of Surgery.2023;[Epub]     CrossRef
  • Research Progress and Thinking on the Surgical Treatment of Siewert Type II Adenocarcinoma of the Esophagogastric Junction
    宏宇 谢
    Advances in Clinical Medicine.2023; 13(02): 1914.     CrossRef
  • The comparison of long-term oncological outcomes and complications after proximal gastrectomy with double tract reconstruction versus total gastrectomy for proximal gastric cancer
    Keming Ying, Weisong Bai, Guiru Yan, Ziseng Xu, Shenheng Du, Chengxue Dang
    World Journal of Surgical Oncology.2023;[Epub]     CrossRef
  • The clinical outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction versus tube-like stomach reconstruction in patients with adenocarcinoma of the esophagogastric junction based on propensity score-matching: a multicenter cohort st
    Zhiwen Xu, Jinping Chen, Shaoqin Chen, Hexin Lin, Kang Zhao, Changyue Zheng, Huibin Liu, Zhihua Chen, Yongan Fu, Qingqi Hong, Wei Lin, Su Yan, Jun You
    Frontiers in Oncology.2023;[Epub]     CrossRef
  • A novel trans hiatal esophago-gastrostomy with anti-reflux triangle-valve for laparoscope assisted lower esophagectomy and proximal gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a three-year retrospective cohort study
    Yongshun Gao, Jiangang Sun, Peng Chen
    European Surgery.2023; 55(5-6): 124.     CrossRef
  • Surgical outcomes of laparoscopic proximal gastrectomy for upper-third gastric cancer: esophagogastrostomy, gastric tube reconstruction, and double-tract reconstruction
    Jianhua Chen, Fei Wang, Shuyang Gao, Yapeng Yang, Ziming Zhao, Jiahao Shi, Liuhua Wang, Jun Ren
    BMC Surgery.2023;[Epub]     CrossRef
  • Minimally invasive surgery for gastro-oesophageal junction adenocarcinoma: Current evidence and future perspectives
    Rodica Bîrlă, Petre Hoara, Florin Achim, Valeriu Dinca, Diana Ciuc, Silviu Constantinoiu, Adrian Constantin
    World Journal of Gastrointestinal Oncology.2023; 15(10): 1675.     CrossRef
  • Comparison of proximal gastrectomy with double-flap technique and double-tract reconstruction for proximal early gastric cancer: a meta-analysis
    Qiao-zhen Huang, Peng-cheng Wang, Yan-xin Chen, Shu Lin, Kai Ye
    Updates in Surgery.2023; 75(8): 2117.     CrossRef
  • Comparison of the prognosis of four different surgical strategies for proximal gastric cancer: a network meta-analysis
    Ling Tan, Meng-ni Ran, Zi-lin Liu, Ling-han Tang, Zhou Ma, Zhou He, Zhou Xu, Fang-han Li, Jiang-wei Xiao
    Langenbeck's Archives of Surgery.2022; 407(1): 63.     CrossRef
  • Protocol for Comparing the Efficacy of Three Reconstruction Methods of the Digestive Tract (Kamikawa Versus Double-Tract Reconstruction Versus Tube-Like Stomach) After Proximal Gastrectomy
    Wei Dong Wang, Rui Qi Gao, Tong Chen, Dan Hong Dong, Qin Chuan Yang, Hai Kun Zhou, Jiang Peng Wei, Peng Fei Yu, Xi Sheng Yang, Xiao Hua Li, Gang Ji
    Frontiers in Surgery.2022;[Epub]     CrossRef
  • A review on double tract reconstruction after proximal gastrectomy for proximal gastric cancer
    Tricia S. Lewis, YongDong Feng
    Annals of Medicine and Surgery.2022; 79: 103879.     CrossRef
  • Clinical Comparison of Proximal Gastrectomy With Double-Tract Reconstruction Versus Total Gastrectomy With Roux-en-Y Anastomosis for Siewert Type II/III Adenocarcinoma of the Esophagogastric Junction
    Xiaoming Ma, Mingzuo Zhao, Jian Wang, Haixing Pan, Jianqiang Wu, Chungen Xing
    Journal of Gastric Cancer.2022; 22(3): 220.     CrossRef
  • Surgical considerations and outcomes of minimally invasive approaches for gastric cancer resection
    Cecilia T. Ong, Jason L. Schwarz, Kevin K. Roggin
    Cancer.2022; 128(22): 3910.     CrossRef
  • 6,646 View
  • 186 Download
  • 25 Web of Science
  • 23 Crossref
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Analysis of Local Recurrence Following Proximal Gastrectomy in Patients with Upper Third Gastric Cancer
Chang Hak Yoo, Byung Ho Sohn, Won Kon Han, Won Kil Pae
Cancer Res Treat. 2002;34(4):247-251.   Published online August 31, 2002
DOI: https://doi.org/10.4143/crt.2002.34.4.247
AbstractAbstract PDF
PURPOSE
Little is known about local recurrence following proximal gastrectomy in patients with upper third gastric cancer. We performed this study to evaluate the long-term results of a proximal gastrectomy, and to analyze the risk factors of local recurrence affecting survival in these patients.
MATERIALS AND METHODS
We undertook a retrospective study of 63 patients who underwent potentially curative proximal gastrectomy between 1990 and 1999, with special reference to local recurrence.
RESULTS
During a median follow-up period of 37 months, 25 of the 63 patients (39.7%) developed a recurrence of cancer, with local recurrence in 15 patients (23.8%), the majority of these occurring at the remnant stomach or anastomosis. The median time to local recurrence was 38 months (8~78 months). Univariate analysis of risk factors for local recurrence revealed an infiltrative or diffuse gross type, with a tumor sizes>5 cm, a distal resection margin CONCLUSION
When performing a proximal gastrectomy for upper third gastric cancer, even after curative resection, all risk factors should be considered to reduce rates of local recurrence.

Citations

Citations to this article as recorded by  
  • Clinicopathologic characteristics in patients with upper third gastric cancer following radical surgical treatment
    Xiaoming Ma, Wei Zhou, Cheng Wang, Wei Miao, Ning Liu, Shigui Wang, Shihao Guan
    Medicine.2018; 97(45): e13017.     CrossRef
  • Recurrence Following Laparoscopy-Assisted Gastrectomy for Gastric Cancer: A Multicenter Retrospective Analysis of 1,417 Patients
    Jyewon Song, Hyuk-Joon Lee, Gyu Seok Cho, Sang-Uk Han, Min-Chan Kim, Seung Wan Ryu, Wook Kim, Kyo Young Song, Hyung-Ho Kim, Woo Jin Hyung
    Annals of Surgical Oncology.2010; 17(7): 1777.     CrossRef
  • Proximal Gastrectomy Reconstructed by Jejunal Pouch Interposition for Upper Third Gastric Cancer: Prospective Randomized Study
    Chang Hak Yoo, Byung Ho Sohn, Won Kon Han, Won Kil Pae
    World Journal of Surgery.2005; 29(12): 1592.     CrossRef
  • Issues in the Management of the Upper Third Gastric Cancer
    Han-Kwang Yang
    Cancer Research and Treatment.2004; 36(1): 4.     CrossRef
  • 3,723 View
  • 21 Download
  • 4 Crossref
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