Siegler Emily L, Grotz Travis E
Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Cancers (Basel). 2025 Jul 24;17(15):2455. doi: 10.3390/cancers17152455.
Proximal gastrectomy (PG) with double tract reconstruction (DTR) offers organ preservation for early gastric cancers, leading to reduced vitamin B12 deficiency, less weight loss, and improved quality of life. The JCOG1401 study confirmed excellent long-term outcomes for PG in stage I gastric cancer. However, in locally advanced proximal gastric cancer (LAPGC), preserving the gastric body and lymph node station 4d may compromise margin clearance and adequate lymphadenectomy. : We propose a modified PG that removes the distal esophagus, gastroesophageal junction (GEJ), cardia, fundus, and gastric body, preserving only the antrum and performing DTR. Lymphadenectomy is also adapted, removing stations 1, 2, 3a, 4sa, 4sb, 4d, 7, 8, 9, 10 (spleen preserving), 11, and lower mediastinal nodes (stations 19, 20, and 110), while preserving stations 3b, 5, and 6. Indications for this procedure include GEJ (Siewert type II and III) and proximal gastric cancers with ≤2 cm distal esophageal involvement and ≤5 cm gastric involvement. In our initial experience with 14 patients, we achieved R0 resection in all patients, adequate lymph node harvest (median 24 nodes, IQR 18-38), and no locoregional recurrences at a median follow-up of 18 months. We also found favorable postoperative weight loss, reflux, and anemia in the PG cohort. While larger studies and long-term data are still needed, our early results suggest that modified PG-despite sparing only the antrum-retains the key benefits of PG over total gastrectomy, including better weight maintenance and improved hemoglobin levels, while maintaining oncologic outcomes for LAPGC.
近端胃切除术（PG）联合双通道重建（DTR）可为早期胃癌患者保留器官，从而减少维生素B12缺乏、减轻体重减轻并改善生活质量。JCOG1401研究证实了PG治疗I期胃癌具有出色的长期疗效。然而，对于局部进展期近端胃癌（LAPGC），保留胃体和第4d组淋巴结可能会影响切缘阴性及充分的淋巴结清扫。我们提出一种改良的PG术式，切除远端食管、胃食管交界部（GEJ）、贲门、胃底和胃体，仅保留胃窦并进行DTR。淋巴结清扫范围也进行了调整，切除第1、2、3a、4sa、4sb、4d、7、8、9、10组（保留脾脏）、11组及下纵隔淋巴结（第19、20和110组），同时保留第3b、5和6组淋巴结。该手术的适应证包括GEJ（Siewert II型和III型）以及远端食管受累≤2 cm且胃受累≤5 cm的近端胃癌。在我们最初对14例患者的经验中，所有患者均实现了R0切除，获得了足够数量的淋巴结（中位数24枚，四分位间距18 - 38枚），且在中位随访18个月时无局部区域复发。我们还发现PG组患者术后体重减轻、反流和贫血情况良好。虽然仍需要更大规模的研究和长期数据，但我们的早期结果表明，改良PG术式——尽管仅保留胃窦——保留了PG相对于全胃切除术的关键优势，包括更好地维持体重和改善血红蛋白水平，同时保持了LAPGC的肿瘤学疗效。
