title: Comparison of perioperative and long-term outcomes of total and proximal gastrectomy for early gastric cancer: a multi-institutional retrospective study.
abstract: BACKGROUND
  Various surgical procedures are used to treat early gastric cancers in the upper third of the stomach (U-EGCs). However, there is no general agreement regarding the optimal surgical procedure.
  
  
  METHODS
  The medical records of 203 patients with U-EGC were collected from 13 institutions. Surgical procedures were classified as Roux-en-Y esophagojejunostomy after total gastrectomy (TG-RY), esophagogastrostomy after proximal gastrectomy (PG-EG), or jejunal interposition after PG (PG-JI). Patient clinical characteristics and perioperative and long-term outcomes were compared among these three groups.
  
  
  RESULTS
  TG-RY, PG-EG, and PG-JI were performed in 122, 49, and 32 patients, respectively. Tumors were larger in TG-RY patients than in PG-EG and PG-JI patients, and undifferentiated-type gastric adenocarcinoma tended to be more frequent in TG-RY than in PG-EG. The operative time was shorter for PG-EG than for PG-JI and TG-RY. Hospital stay and early postoperative complications were not different for the three procedures. With respect to gastrectomy-associated symptoms, a "stuck feeling" and heartburn tended to be more frequent in PG-EG patients, while dumping syndrome and diarrhea were more frequent in TG-RY patients. Post-surgical weight loss was not different among the three groups, however, serum albumin and hemoglobin levels tended to be lower in TG-RY patients.
  
  
  CONCLUSIONS
  Three surgical procedures for U-EGC did not result in differences in weight loss, but PG-EG and PG-JI were better than TG-RY according to some nutritional markers. In U-EGC, where patients are expected to have long survival times, PG-EG and PG-JI should be used rather than TG-RY.
authors: Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
authors: Toru
authors: T
authors: Masuzawa
authors: Shuji
authors: S
authors: Takiguchi
authors: Motohiro
authors: M
authors: Hirao
authors: Hiroshi
authors: H
authors: Imamura
authors: Yutaka
authors: Y
authors: Kimura
authors: Junya
authors: J
authors: Fujita
authors: Isao
authors: I
authors: Miyashiro
authors: Shigeyuki
authors: S
authors: Tamura
authors: Masahiro
authors: M
authors: Hiratsuka
authors: Kenji
authors: K
authors: Kobayashi
authors: Yoshiyuki
authors: Y
authors: Fujiwara
authors: Masaki
authors: M
authors: Mori
authors: Yuichiro
authors: Y
authors: Doki
mesh_terms: D000230:Adenocarcinoma; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome