Cancer Research and Treatment

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

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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

Pancreatic atrophy after gastric cancer surgery: influencing factors and effects on BMI and quality of life
Zhaoping Li, Lianlian Cao, Hao Chen, Feng Wang, Liang Tao, Meng Wang
World Journal of Surgical Oncology.2025;[Epub] CrossRef
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

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Role of Distal Pancreatectomy on the Prognosis of Gastric Cancer Patients Undergoing Total Gastrectomy: Sang Uk Han, Yong Kwan Cho, Bong Wan Kim, Tae Hee Kim, Myung Wook Kim; J Korean Cancer Assoc. 1999;31(5):955-963.

Abstract PDF: PURPOSE
A distal pancreatectomy was often simultaneously performed with splenectomy and total gastrectomy in the treatment of gastric carcinoma for complete removal of lymph nodes around the splenic artery. However, pancreatic juice leakage, subphrenic abscess, and postoperative diabetes were common complications in patients treated by pancreas resection. We performed a retrospective analysis to evaluate the role of distal pancreatectomy on the prognosis of gastric cancer patients.
MATERIALS AND METHODS
The effect of distal pancreatectomy on survival was studied by examination of the records of 120 patients who underwent splenectomy and total gastrectomy for gastric carcinoma with serosal invasion. Of these, 75 underwent pancreas preserving splenectomy and 45 underwent pancreaticosplenectomy. Prognostic factors and postoperative complications were evaluated according to the operation types.
RESULTS
The addition of distal pancreatectomy to splenectomy with total gastrectomy for patients with gastric cancer was not associated with severe complications. And patients underwent pancreaticosplenectomy showed similar survival as those underwent pancreas preserving splenectomy.
CONCLUSION
Distal pancreatectomy for the gastric cancer patients with suspected metastatic lymph nodes around the splenic artery could be recommended for the purpose of radical lymph node dissection.

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Clinical Analysis of 329 Cases of Total Gastrectomy: Woo Sung Lee, Nam Sun Paik, Seon Mi Moon, Woo Chul Noh, Ho Yoon Bang, Dong Wook Choi, Jong Inn Lee, Nan Mo Moon; J Korean Cancer Assoc. 1998;30(1):63-71.

Abstract PDF: PURPOSE
This study was designed to evaluate the safety including the morbidity and mortality of total gastrectomy and combined organ resection, to examine the survival rate and the prognostic factors of gastric cancer following the total gastrectomy and to assess the prognostic predictability of new UICC staging system after surgery in gastric cancer patients. MATERIAL AND METHOD: To evaluate demographic features, clinical presentations, preoperative diagnostic accuracy, postoperative complications and prognostic factors, we analyzed 329 patients who underwent the total gastrectomy or the total gastrectomy with combined resection for gastric malignancy at KCCH from Jan. 1990 to Dec. 1993 retrospectively.
RESULTS
The early postoperative complication rates of overall patients and combined resection group were 9.1% and 8.9%. Mortality of these were 0.9% and 1.1%(p>0.05). The overall 5YSR was 52.8% and there was no significant differrence in the survival rate between the total gastrectomy only group and the combined resection group. The accuracy of preoperative UGIS and abdominal CT for determiantion of resectability were over 80%. The depth of invasion and lymph node metastasis were independent prognostic factors.
CONCLUSION
The total gastrectomy with combined resection should be considered when indicated, because the postoperative morbidity and mortality is low and long term survival is expected. The new UICC staging system seems to be good to predict prognosis in gastric cancer patients.

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The Prognostic Effects of Spleen Preservation in The Radical Total Gastrcomy: Hee Duck Kim, Chung Han Lee, Kyung Hyun Choi, Seung Do Lee, Jae Kwan Suh; J Korean Cancer Assoc. 1994;26(2):198-208.

Abstract PDF: In Gastric Cancer Surgery, an extended radical operation is common procedure, and in cases of total gastrectomy, there is a tendency to perform splenectomy at the same time. However, regarding to the prophylactic splenectamy for clearing of spleen hilar nodes the prognostic ef- fectivity is controversiaL We studied the value of spleen preservation in total gastrectomy for gastric cancer by survival rate, according to tumor stage and tumor location and by inflammatory complications. And another study was done on cellular immunity of total gastrectomy patients by T-cell subset(T3T4T5 & T4T8 Ratio) and Natural Killer cell activity changes(preoperative day and postoperative 2 months) with or without combined splenectomy. In five year survival rate of stage I and II groups, spleen preserving group(78.7%) has better prognosis than splenectomized group(70.4%) and in stage III and IV groups, 5 year survival rate of nonsplenectomized cases(30%) showed higher than that of splenectomized cases(17%). Five year survival rate of nonsplenectomized, proximal gastric cancer group(57.5%) showed significantly better than that of splenectomized group(30%). Postoperative T4/T8, ratio and NK cell activity were markedly decreased compared to preoperative ratio in the splenectomized group than the non-splenectomized and control groups. Consequently spleen preserving group group had better prognosis than splenectomized group in total gastrectomy, which may be attributable in part to reduction of cellular immunity caused by splenectomy. It seems to be desirable that accordingly prophylactic splenectomy in gastric cancer surgery should be reconsidered.

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Comparison of Nutritional Status after Subtotal Gastrectomy according to Reconstruction Methods: Hang Jong Yu, Han Kwang Yang, Jin Pok Kim; J Korean Cancer Assoc. 1996;28(4):710-718.

Abstract PDF: The purpose of this study is to compare nutritional status in subtotal gastrectomised patients according to reconstruction methods: Billroth I, retrocolic Billroth II and antecolic Billroth II anatomoses. For this study 90 early gastric cancer patients who underwent radical subtotal gastrectomy with Billroth I(B-I: n=30), retrocolic Billrath II(B-IIR: n=30) or antecolic Billroth II(B-IIA: n=30) anastomosis were selected to examine anthropometric and laboratory data. The results were; 1) In all three groups, there were significant weight losses(B-I: 4.5¡¾3.I Kg, B-IIR: 5.0¡¾3.2 Kg, B-IIA: 5.6¡¾4.0 Kg) and there were more weight losses in B-IIA group than B-IIR group and B-I group. 2) Triceps skin fold thickness showed that there were moderate to severe fat malnutrition in about 70% of patients in all three groups. 3) Arm muscle circumference showed that there were moderate to severe protein malnu trition in about 30% of patients in all three groups. 4) Serum albumin and transferrin levels showed normal levels in almost all patients and no differences among three groups. 5) Blood hemoglobin and serum calcium levels showed decrement compared to preoperative levels but no differences among three groups. 6) Serum Vitamine B12 level showed statistically significant decreased level in B-II group, more likely in B-IIA group. In summary, there were more weight losses in B-IIA group, and statistically significant decreased vitamin B12 level in B-II group, more likely in B-IIA group. So we recommend vitamin B12 supplement from 2 years after subtotal gastrectomy with Biillroth II anastomosis.

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