Diffuse-type Proximal Advanced Gastric Cancer After Radical Total Gastrectomy: A Clinical Study

Background and aims: Proximal and diffuse-type gastric cancers(GC) have an increasing trend of incidence in recent years. A series of studies have shown these patients have a poor prognosis. However, few data are available to compare curative total gastrectomy(TG) with cura tive proximal gastrectomy(PG) for the treatment of diffuse-type proximal advanced gastric cancer(PAGC). This study aimed to compare the oncologic efficacy and long-term outcomes of these two groups.Methods: A total of 60 TG and 83 PG were retrospectively enrolled in this study between 2009 and 2015, and we analyzed data from 50 cases of TG and matched 50 PG after a propensity score matching method. The clinicopathological characteristics, operative outcomes and postoperative complications of the matched patients were compared.Results: The clinicopathological data of patients were similar in two groups. Among these matched patients, no significant differences were found in the TG group compared with the PG group with regard to the operative method and time, number of positive lymph nodes, vascular and perineural invasion, time to first flatus and oral intake, intraoperative blood loss and postoperative hospital stay. The number of retrieved lymph nodes was more in the TG group than in the PG group(36.9±13.4 vs. 31.4±11.2, P = 0.001). The rate of positive surgical margin was less in the TG group than in the PG group(2% vs. 14%, P = 0.029). The total complication rate in the TG group was lower than in the PG group(6% vs. 20%, P = 0.037), although there was no significant difference between C lavien-Dindo classification of postoperative complication(P = 0.269). During median follow-up of 26(range: 3-64) months, these were significant differences in the 3-year overall survival(OS) rate(52% vs. 38%, P = 0.046) and progression-free survival(PFS) rate(46% vs. 22%, P = 0.010) between the groups.Conclusions: This study suggests that curative TG is safe and feasible for patients with diffuse-type PAGC with better short-term and long-term clinical outcomes as compared to conventional PG.