Transpacific multicenter collaborative study of minimally invasive proximal gastrectomy vs. minimally invasive total gastrectomy for proximal gastric and gastroesophageal junction cancers: 3-month follow-up results

Abstract

Background Total gastrectomy (TG) remains the standard surgical approach for proximal gastric and gastroesophageal junction (P/GEJ) cancers. However, experts increasingly perform proximal gastrectomy (PG) with anti-reflux reconstruction. The benefits of minimally invasive PG (MIPG) over minimally invasive TG (MITG), particularly regarding postoperative quality of life (QoL), remain unclear. Methods We conducted a transpacific, multicenter, nonrandomized, prospective cohort study to compare symptom burden outcomes (symptom occurrence, symptom severity, and daily functioning) between MIPG and MITG in patients with P/GEJ cancers. Symptom burden data was collected using the MD Anderson Symptom Inventory (MDASI-GI +). Results Among 71 patients with P/GEJ cancers enrolled from 2022 through 2024, 64 underwent either MITG (n = 26, 41%) or MIPG (n = 38, 59%). Thirty-nine (61%) patients were treated at Asian centers, and 25 (39%) patients were treated at U.S. centers. Compared to the MIPG patients, the MITG patients had a larger mean tumor size (5.7 vs. 2.3 cm) and a higher prevalence of signet ring cell histology (50 vs. 18%). Operation times were comparable between the MITG and MIPG groups (median: 288.5 vs. 277.0 min), as were the rates of postoperative complications (19 vs. 24%), anastomotic leaks (0 vs. 3%), 90-day mortality (0 vs. 3%), and positive proximal margins (8 vs. 0%, all p > 0.05). QoL data (MDASI-GI +) were collected from at least 95% of patients at all time points. Key metrics related to QoL-appetite, reflux, total symptom burden, and functional interference-did not differ significantly between groups at 1 and 3 months postoperatively. A linear mixed-effects model showed that body-weight trajectories over time did not differ significantly between the MITG and MIPG groups, and there was no significant difference between their highest weight loss percentages within the first 3 months postoperatively. At postoperative month 3, hemoglobin, albumin, vitamin B12, and ghrelin levels were comparable between the groups. Conclusion MIPG and MITG demonstrated equivalent short-term safety, and MIPG did not confer measurable QoL advantages, including in appetite, within 3 months after surgery. Longer-term follow-up is ongoing to evaluate potential delayed advantages.