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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)

Gastric Cancer, 2018, Vol.21(5), pp.845-852 [Peer Reviewed Journal]

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  • Title:
    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)
  • Author: Rosa, Fausto ; Quero, Giuseppe ; Fiorillo, Claudio ; Bissolati, Massimiliano ; Cipollari, Chiara ; Rausei, Stefano ; Chiari, Damiano ; Ruspi, Laura ; de Manzoni, Giovanni ; Costamagna, Guido ; Doglietto, Giovanni ; Alfieri, Sergio
  • Found In: Gastric Cancer, 2018, Vol.21(5), pp.845-852 [Peer Reviewed Journal]
  • Subjects: Upper third gastric cancer ; Total gastrectomy ; Proximal gastrectomy
  • Language: English
  • Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s10120-018-0804-3 Byline: Fausto Rosa (1), Giuseppe Quero (1), Claudio Fiorillo (1), Massimiliano Bissolati (2), Chiara Cipollari (3), Stefano Rausei (4), Damiano Chiari (2), Laura Ruspi (4), Giovanni de Manzoni (3), Guido Costamagna (5), Giovanni Battista Doglietto (1), Sergio Alfieri (1) Keywords: Upper third gastric cancer; Total gastrectomy; Proximal gastrectomy 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. Author Affiliation: (1) 0000 0001 0941 3192, grid.8142.f, Department of Digestive Surgery, "A. Gemelli" Hospital, Catholic University of Rome, Largo A. Gemelli, 8, 00168, Rome, Italy (2) grid.15496.3f, Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy (3) 0000 0004 1763 1124, grid.5611.3, 1st Division of Surgery, University of Verona, Verona, Italy (4) 0000000121724807, grid.18147.3b, Department of Surgical Sciences, University of Insubria (Varese-Como), Varese, Italy (5) 0000 0001 0941 3192, grid.8142.f, Department of Digestive Endoscopy, "A. Gemelli" Hospital, Catholic University of Rome, Rome, Italy Article History: Registration Date: 29/01/2018 Received Date: 22/07/2017 Accepted Date: 27/01/2018 Online Date: 08/02/2018 Article note: The results of this paper were presented as Oral Presentation at the 12th International Gastric Cancer Congress held in Beijing (China) on 20--23 April 2017.
  • Identifier: ISSN: 1436-3291 ; E-ISSN: 1436-3305 ; DOI: 10.1007/s10120-018-0804-3

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