Comparable hematologic and nutritional outcomes of proximal gastrectomy with double-tract reconstruction compared with total gastrectomy for early gastric cancer in the upper stomach

Abstract

Potential benefits of proximal gastrectomy in terms of hematologic and nutritional outcomes over total gastrectomy have been theoretically suggested in several studies. However, no proven evidences for the hematological and nutritional outcomes have been demonstrated. Thus, we compared hematologic and nutritional outcomes after proximal gastrectomy with double-tract reconstruction with those after total gastrectomy. From September 2014 to December 2015, there were 80 patients underwent minimally invasive surgery, proximal gastrectomy or total gastrectomy, for stage I gastric cancer. We divided patients into two groups: proximal gastrectomy group, 38 patients underwent proximal gastrectomy with double-tract reconstruction and total gastrectomy group, 42 patients underwent total gastrectomy. We retrospectively analyzed clinicopathologic, hematologic, and nutritional features. We found no significant differences in hematologic outcomes. Change of hemoglobin level and cumulative incidence of iron deficiency anemia between the two groups were similar (p = 0.250 and 0.971, respectively) with a median follow up period of 24 months (range 18 – 30 months) after surgery. Cumulative incidence of vitamin B12 deficiency did not significantly differ between the proximal gastrectomy group and the total gastrectomy group (p = 0.087). There was no significant difference in the patients’ BMI changes from baseline between the proximal gastrectomy group and the total gastrectomy group (p = 0.591). In the nutritional features, there were no statistically significant differences. This study showed that proximal gastrectomy with double-tract reconstruction and total gastrectomy have no statistically different outcomes in terms of hematologic and nutritional aspect, especially in emergence of iron deficiency and vitamin B12 deficiency anemia. In conclusion, for patients with gastric cancer located in upper third of the stomach, proximal gastrectomy with double-tract reconstruction can be considered as an alternative option with comparable outcomes of total gastrectomy, if oncological safety is assured.