Clinical outcomes of proximal gastrectomy versus total gastrectomy for locally advanced proximal gastric cancer: a propensity score matching analysis

Background: The safety and efficacy of proximal gastrectomy (PG) following for locally advanced proximal gastric cancer (LAPGC) were unclear, as oncologic outcomes of randomized trials are still pending. The aim of this study was to evaluate surgical results and long-term oncologic outcomes of PG versus total gastrectomy (TG) in treating locally advanced gastric cancer (LAGC). Methods: A total of 2,918 LAPGC patients with PG or TG were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) 1998-2018. Propensity score matching was employed to match patients with PG or TG in a 1:1 ratio. Surgery outcomes and overall survival (OS) rates were compared between PG and TG groups after the propensity-score match. Cox proportional hazards model was used to explore the risk factors for OS. Results: Of 2,918 patients, 181 (6.20%) underwent TG, while 2,737 (93.80%) underwent PG. After propensity score matching, 150 matched pairs for PG and TG were selected. Compared with TG group, PG group had shorter operative time (181.8 +/- 49.8 vs. 213.5 +/- 66.7 min, P<0.001) and less estimated blood transfusion (10.00% vs. 22.67%, P=0.001). More lymph nodes (34 .3 +/- 17.0 vs. 24.2 +/- 11.0, P<0.001) were retrieved in TG group than in PG group. The 3- and 5-year OS rates (79.1% vs. 77.2% and 74.5% vs. 72.0%, respectively, both P<0.001) in PG group were slightly higher than ones in TG group. However, the multivariable results showed that there was no significant difference in the OS status between the two groups (HR: 1.172, 95% CI: 0.916-1.499, P=0.208), even stratified into stage II and III subgroup. Conclusions: In conclusion, the extent of resection for LAPGC patients did not influence the long-term survival outcomes. Moreover, future randomized clinical trials of quality of life following PG or TG are expected to assist surgeons in the choice of surgical approach and strategy for LAPGC patients.