Comparison of surgical outcomes and postoperative nutritional parameters between subtotal and proximal gastrectomy in patients with proximal early gastric cancer

Aim: In this study, we evaluated the difference in short-term outcomes and postoperative nutritional status between subtotal gastrectomy (sTG) and proximal gastrectomy (PG) to determine the optimal surgical treatment for early gastric cancer in the upper third of the stomach.

Methods: Patients who underwent laparoscopic or robotic sTG or PG at the Shizuoka Cancer Center in Shizuoka between January 2014 and December 2020 were enrolled in this retrospective study. Patient characteristics, surgical outcomes, endoscopic findings, and postoperative nutritional changes, including blood tests, body weight, psoas muscle, and subcutaneous and visceral adipose tissue, were measured and compared between the two groups.

Results: A total of 110 patients were enrolled, including 42 in the sTG group and 68 in the PG group. Albumin and hemoglobin levels were comparable between the two groups. Changes in body weight and psoas mass index measured over 36 months postoperatively were favorable in the sTG group compared with the PG group (p = 0.005 and p = 0.002, respectively). There were no significant differences in subcutaneous or visceral adipose tissue between the two groups (p = 0.331 and 0.845, respectively).

Conclusion: sTG is the preferred function-preserving gastrectomy procedure for early gastric cancer in the upper third of the stomach because it is associated with less postoperative body weight loss and psoas mass index loss.