Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach: a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG)

Fausto Rosa, Giuseppe Quero, Claudio Fiorillo, Massimiliano Bissolati, Chiara Cipollari, Stefano Rausei, Damiano Chiari, Laura Ruspi, Giovanni de Manzoni, Guido Costamagna, Giovanni Battista Doglietto, Sergio Alfieri

Research output: Contribution to journalArticle

Abstract

Background: The aim of this study is to compare surgical outcomes including postoperative complications and prognosis between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer (GC). Propensity-score-matching analysis was performed to overcome patient selection bias between the two surgical techniques. Methods: Among 457 patients who were diagnosed with GC between January 1990 and December 2010 from four Italian institutions, 91 underwent PG and 366 underwent TG. Clinicopathologic features, postoperative complications, and survivals were reviewed and compared between these two groups retrospectively. Results: After propensity-score matching had been done, 150 patients (75 TG patients, 75 PG patients) were included in the analysis. The PG group had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the TG group. N stages and 5-year survival rates were similar after TG and PG. Postoperative complication rates after PG and TG were 25.3 and 28%, respectively, (P = 0.084). Rates of reflux esophagitis and anastomotic stricture were 12 and 6.6% after PG and 2.6 and 1.3% after TG, respectively (P < 0.001 and P = 0.002). 5-year overall survival for PG and TG group was 56.7 and 46.5%, respectively (P = 0.07). Survival rates according to the tumor stage were not different between the groups. Multivariate analysis showed that type of resection was not an independent prognostic factor. Conclusion: Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.

Original languageEnglish
Pages (from-to)845-852
Number of pages8
JournalGastric Cancer
Volume21
Issue number5
DOIs
Publication statusPublished - Sep 1 2018

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Propensity Score
Gastrectomy
Stomach
Adenocarcinoma
Research
Stomach Neoplasms
Peptic Esophagitis
Survival
Pathologic Constriction
Survival Rate
Selection Bias

Keywords

  • Proximal gastrectomy
  • Total gastrectomy
  • Upper third gastric cancer

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach : a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG). / Rosa, Fausto; Quero, Giuseppe; Fiorillo, Claudio; Bissolati, Massimiliano; Cipollari, Chiara; Rausei, Stefano; Chiari, Damiano; Ruspi, Laura; de Manzoni, Giovanni; Costamagna, Guido; Doglietto, Giovanni Battista; Alfieri, Sergio.

In: Gastric Cancer, Vol. 21, No. 5, 01.09.2018, p. 845-852.

Research output: Contribution to journalArticle

Rosa, Fausto ; Quero, Giuseppe ; Fiorillo, Claudio ; Bissolati, Massimiliano ; Cipollari, Chiara ; Rausei, Stefano ; Chiari, Damiano ; Ruspi, Laura ; de Manzoni, Giovanni ; Costamagna, Guido ; Doglietto, Giovanni Battista ; Alfieri, Sergio. / Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach : a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG). In: Gastric Cancer. 2018 ; Vol. 21, No. 5. pp. 845-852.
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abstract = "Background: The aim of this study is to compare surgical outcomes including postoperative complications and prognosis between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer (GC). Propensity-score-matching analysis was performed to overcome patient selection bias between the two surgical techniques. Methods: Among 457 patients who were diagnosed with GC between January 1990 and December 2010 from four Italian institutions, 91 underwent PG and 366 underwent TG. Clinicopathologic features, postoperative complications, and survivals were reviewed and compared between these two groups retrospectively. Results: After propensity-score matching had been done, 150 patients (75 TG patients, 75 PG patients) were included in the analysis. The PG group had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the TG group. N stages and 5-year survival rates were similar after TG and PG. Postoperative complication rates after PG and TG were 25.3 and 28{\%}, respectively, (P = 0.084). Rates of reflux esophagitis and anastomotic stricture were 12 and 6.6{\%} after PG and 2.6 and 1.3{\%} after TG, respectively (P < 0.001 and P = 0.002). 5-year overall survival for PG and TG group was 56.7 and 46.5{\%}, respectively (P = 0.07). Survival rates according to the tumor stage were not different between the groups. Multivariate analysis showed that type of resection was not an independent prognostic factor. Conclusion: Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.",
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T1 - Total vs proximal gastrectomy for adenocarcinoma of the upper third of the stomach

T2 - a propensity-score-matched analysis of a multicenter western experience (On behalf of the Italian Research Group for Gastric Cancer–GIRCG)

AU - Rosa, Fausto

AU - Quero, Giuseppe

AU - Fiorillo, Claudio

AU - Bissolati, Massimiliano

AU - Cipollari, Chiara

AU - Rausei, Stefano

AU - Chiari, Damiano

AU - Ruspi, Laura

AU - de Manzoni, Giovanni

AU - Costamagna, Guido

AU - Doglietto, Giovanni Battista

AU - Alfieri, Sergio

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: The aim of this study is to compare surgical outcomes including postoperative complications and prognosis between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer (GC). Propensity-score-matching analysis was performed to overcome patient selection bias between the two surgical techniques. Methods: Among 457 patients who were diagnosed with GC between January 1990 and December 2010 from four Italian institutions, 91 underwent PG and 366 underwent TG. Clinicopathologic features, postoperative complications, and survivals were reviewed and compared between these two groups retrospectively. Results: After propensity-score matching had been done, 150 patients (75 TG patients, 75 PG patients) were included in the analysis. The PG group had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the TG group. N stages and 5-year survival rates were similar after TG and PG. Postoperative complication rates after PG and TG were 25.3 and 28%, respectively, (P = 0.084). Rates of reflux esophagitis and anastomotic stricture were 12 and 6.6% after PG and 2.6 and 1.3% after TG, respectively (P < 0.001 and P = 0.002). 5-year overall survival for PG and TG group was 56.7 and 46.5%, respectively (P = 0.07). Survival rates according to the tumor stage were not different between the groups. Multivariate analysis showed that type of resection was not an independent prognostic factor. Conclusion: Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.

AB - Background: The aim of this study is to compare surgical outcomes including postoperative complications and prognosis between total gastrectomy (TG) and proximal gastrectomy (PG) for proximal gastric cancer (GC). Propensity-score-matching analysis was performed to overcome patient selection bias between the two surgical techniques. Methods: Among 457 patients who were diagnosed with GC between January 1990 and December 2010 from four Italian institutions, 91 underwent PG and 366 underwent TG. Clinicopathologic features, postoperative complications, and survivals were reviewed and compared between these two groups retrospectively. Results: After propensity-score matching had been done, 150 patients (75 TG patients, 75 PG patients) were included in the analysis. The PG group had smaller tumors, shorter resection margins, and smaller numbers of retrieved lymph nodes than the TG group. N stages and 5-year survival rates were similar after TG and PG. Postoperative complication rates after PG and TG were 25.3 and 28%, respectively, (P = 0.084). Rates of reflux esophagitis and anastomotic stricture were 12 and 6.6% after PG and 2.6 and 1.3% after TG, respectively (P < 0.001 and P = 0.002). 5-year overall survival for PG and TG group was 56.7 and 46.5%, respectively (P = 0.07). Survival rates according to the tumor stage were not different between the groups. Multivariate analysis showed that type of resection was not an independent prognostic factor. Conclusion: Although PG for upper third GC showed good results in terms of survival, it is associated with an increased mortality rate and a higher risk of reflux esophagitis and anastomotic stricture.

KW - Proximal gastrectomy

KW - Total gastrectomy

KW - Upper third gastric cancer

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