Ding Shikang, Zheng Xiaohao, Wang Shenghui, Wu Ming, Wu Yunzi, Sun Chunyang, Yang Lin, Xue Liyan, Wang Bingzhi, Wang Chengfeng, Xie Yibin
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of General Surgery, Civil Aviation General Hospital, Beijing, China.
Front Oncol. 2022 Oct 25;12:973902. doi: 10.3389/fonc.2022.973902. eCollection 2022.
To compare the long-term nutritional status, reflux esophagitis and anastomotic stenosis, between total gastrectomy (TG) and proximal gastrectomy (PG).
Patients 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.
Totally 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.
TG 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.
比较全胃切除术（TG）和近端胃切除术（PG）之间的长期营养状况、反流性食管炎和吻合口狭窄情况。
纳入2014年1月至2016年12月在该单一机构接受PG或TG的患者。定义了纳入和排除标准。通过人口统计学和病理特征进行一对一倾向评分匹配（PSM），以比较两组之间的长期结局。主要终点是长期营养状况，次要终点是反流性食管炎和吻合口狭窄。长期营养状况通过体重指数百分比（%BMI）、体重以及包括总蛋白、前白蛋白、血红蛋白和白细胞总数的血液检查来评估。
2014年1月至2016年12月期间，共有460例患者在本机构接受PG或TG治疗，根据纳入和排除标准，最终226例患者纳入本研究。PG或TG后前5年末的营养状况无显著差异。而PG组的反流性食管炎和吻合口狭窄显著高于TG组（分别为54.4%对26.8%，p<0.001；14.9%对4.5%，p=0.015）。PSM后两组的总生存率相似（PG组和TG组的5年生存率分别为65.4%对61.5%；p=0.54）。该组患者PG后残胃癌发生率为3.5%。
与PG相比，TG在营养状况相似、反流性食管炎和吻合口狭窄显著更低且无残胃癌方面，应更积极地被推荐。
