Shimoyama Hayato, Haruta Shusuke, Fujisawa Kentoku, Ogawa Yusuke, Ohkura Yu, Ueno Masaki, Udagawa Harushi
Department of Upper Gastrointestinal Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
World J Surg Oncol. 2025 Jul 18;23(1):288. doi: 10.1186/s12957-025-03946-4.
Proximal gastrectomy is commonly performed for early upper-third gastric cancers; however, in no studies have the long-term outcomes of total and proximal gastrectomy been compared for clinically advanced upper-third gastric cancer. We assessed the outcomes of both techniques in this context.
Patients who underwent proximal or total gastrectomy for clinically advanced upper-third gastric cancer (tumor diameter ≤ 50 mm) between June 1994 and July 2021 at Toranomon Hospital, Japan, were included. We compared overall and relapse-free survival between the total gastrectomy (TG) and proximal gastrectomy (PG) groups using inverse probability of treatment weighting, analyzed whether the surgical technique was an independent risk factor for death or recurrence using a Cox proportional hazards model, and evaluated the therapeutic effect using the therapeutic value index for the lymph nodes dissected in TG but undissected in PG.
We investigated 45 and 35 patients in the TG and PG groups, respectively. The 5-year overall and relapse-free survival of the TG and PG groups were 59.4% vs. 61.2%, P = 0.921; and 56.5% vs. 57.1%, P = 0.984; respectively. Surgical technique was not an independent risk factor for death or recurrence. The therapeutic value indexes of the relevant lymph nodes (#3b/4d/5/6/12a) were all zero.
Proximal gastrectomy for relatively small clinically advanced upper-third gastric cancer may be acceptable because its 5-year overall and relapse-free survival do not differ significantly from that of total gastrectomy, it is not an independent risk factor for death or recurrence, and no therapeutic effect for the omitted lymph nodes was revealed.
近端胃切除术常用于治疗早期胃上部癌；然而，对于临床进展期胃上部癌，尚无研究比较全胃切除术和近端胃切除术的长期疗效。在此背景下，我们评估了这两种手术方式的疗效。
纳入1994年6月至2021年7月在日本东京都虎之门医院接受近端或全胃切除术治疗临床进展期胃上部癌（肿瘤直径≤50mm）的患者。我们采用治疗权重逆概率法比较全胃切除术（TG）组和近端胃切除术（PG）组的总生存率和无复发生存率，使用Cox比例风险模型分析手术方式是否为死亡或复发的独立危险因素，并使用治疗价值指数评估TG组切除但PG组未切除的淋巴结的治疗效果。
我们分别对TG组的45例患者和PG组的35例患者进行了研究。TG组和PG组的5年总生存率和无复发生存率分别为59.4%对61.2%，P = 0.921；以及56.5%对57.1%，P = 0.984。手术方式不是死亡或复发的独立危险因素。相关淋巴结（#3b/4d/5/6/12a）的治疗价值指数均为零。
对于相对较小的临床进展期胃上部癌，近端胃切除术可能是可接受的，因为其5年总生存率和无复发生存率与全胃切除术相比无显著差异，它不是死亡或复发的独立危险因素，并且未发现对遗漏淋巴结有治疗效果。
