Safety and feasibility of subtotal resection of the remnant stomach for remnant gastric cancer: A propensity score matching analysis compared with completion total gastrectomy

Abstract

Introduction: Completion total gastrectomy (CTG) has mostly been performed despite the lack of standardized surgical treatment for remnant gastric cancer (RGC) in current guidelines. To enhance a patient's postoperative nutritional status and improve their quality of life by preserving the organ, it is necessary to investigate the role of subtotal resection of the remnant stomach (SR) for RGC. This study aimed to evaluate the efficacy of SR by comprehensively comparing its surgical and oncological outcomes with those of CTG for RGC.

Methods: From January 2001 to December 2022, 229 patients who underwent gastrectomy for RGC, 19 (8.3 %) SR and 210 (91.7 %) CTG, were retrospectively reviewed. Short- and long-term outcomes, including nutritional status, were compared between the two groups after propensity score matching.

Results: Fifty-four patients were selected after propensity score matching (SR = 18, CTG = 36). The SR group demonstrated significantly shorter operative time (199.9 ± 47.7 min vs. 250.6 ± 67.9 min; P = 0.003), fewer postoperative complications (22.2 % vs. 61.1 %; P = 0.007), and less body weight loss and vitamin B12 deficiency (P = 0.039 and P = 0.007, respectively) than the CTG group. There was no difference in the 5-year overall and relapse-free survival rates between the SR and CTG groups (77.8 % and 69.9 %, 83.3 % and 75.6 %, respectively; P = 0.799 and P = 0.578, respectively).

Conclusion: SR showed better surgical outcomes and postoperative nutritional status than CTG, with oncological outcomes similar to those of CTG. Thus, SR may be a safe and effective treatment option for RGC.