AI Article Synopsis
- A recent study analyzed the outcomes of patients with proximal gastric cancer who underwent total gastrectomy (TG) versus proximal gastrectomy (PG) after neoadjuvant chemotherapy (NAC).
- The study included 7616 patients, revealing that a higher percentage of PG patients received NAC compared to those who underwent TG.
- Although the surgical type did not significantly impact long-term survival, NAC was linked to better overall survival rates for both TG and PG patients.
- The findings suggest that PG could be a viable surgical option for certain patients following chemotherapy treatment.
Article Abstract
Background: A steady increase in gastroesophageal junction and proximal gastric cancer (GC) incidence has been observed in the West. Given recent advances in neoadjuvant chemotherapy (NAC), we sought to characterize short- and long-term outcomes of patients with proximal GC who underwent total (TG) vs proximal gastrectomy (PG).
Methods: Patients with stage II/III proximal GC who underwent curative-intent treatment between 2009 and 2019 were identified using National Cancer Database. Multivariable analysis was used to identify oncologic outcomes after TG vs PG.
Results: Among 7616 patients with GC who underwent surgical resection, PG and TG were performed on 5246 (68.8%) and 2370 patients (31.2%), respectively. Patients who underwent PG were more likely to receive NAC (TG 52.3% vs PG 64.5%) (P < .001). On pathologic analysis, patients who underwent TG were more likely to have pT4 tumors (TG 11.7% vs PG 3.1%), metastatic lymph nodes (LNs) (TG 64.6% vs PG 60.4%), and >16 LNs evaluated (TG 64.1% vs PG 53.1%), yet a lower likelihood of negative resection margins (TG 86.6% vs PG 90.0%) (all P < .001). Although gastrectomy procedure type did not affect long-term survival, receipt of NAC was associated with overall survival (OS) among patients who underwent TG (5-year OS, NAC 43.5% vs no NAC 24.6%) and PG (5-year OS, NAC 43.1% vs no NAC 26.7%) (both P < .001).
Conclusion: PG may be an alternative surgical approach to TG in well-selected patients with proximal GC after administration of preoperative systemic chemotherapy.
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| http://dx.doi.org/10.1016/j.gassur.2024.03.017 | DOI Listing |
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