Can Proximal Gastrectomy with Double-Tract Reconstruction Replace Total Gastrectomy? A Propensity Score Matching Analysis

被引:28
作者
Ko, Hyo Jung [1 ,2 ]
Kim, Ki Hyun [1 ,2 ]
Lee, Si-Hak [1 ,2 ]
Choi, Cheol Woong [3 ]
Kim, Su Jin [3 ]
Choi, Chang In [4 ]
Kim, Dae-Hwan [4 ]
Kim, Dong-Heon [4 ]
Hwang, Sun-Hwi [1 ,2 ]
机构
[1] Pusan Natl Univ, Dept Surg, Yangsan Hosp, Yangsan 50612, Gyeongsangnam D, South Korea
[2] Pusan Natl Univ, Res Inst Convergence Biomed Sci & Technol, Yangsan Hosp, Yangsan 50612, Gyeongsangnam D, South Korea
[3] Pusan Natl Univ, Dept Internal Med, Yangsan Hosp, Yangsan, South Korea
[4] Pusan Natl Univ, Dept Surg, Pusan, South Korea
关键词
Proximal gastrectomy; Double-tract reconstruction; Total gastrectomy; Upper gastric cancer; Propensity score matching; QUALITY-OF-LIFE; GASTRIC-CANCER; SURGICAL COMPLICATIONS; NATIONWIDE SURVEY; CLASSIFICATION; MALNUTRITION;
D O I
10.1007/s11605-019-04195-z
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background This retrospective cohort study compared proximal gastrectomy (PG) with double-tract reconstruction (DTR) versus total gastrectomy (TG) with Roux-en-Y reconstruction in terms of clinical outcomes. Methods All consecutive patients with upper early gastric cancer (EGC) who underwent PG-DTR or TG in 2008-2016 were selected. TG patients who matched PG-DTR patients in age, sex, body mass index, clinical stage, and ASA score were selected by propensity score matching. Groups were compared in terms of clinicopathological characteristics, clinical outcomes, early (<= 30 days), late (> 30 days), and severe (Clavien-Dindo grade >= III) postoperative complications, 1-year reflux morbidity, recurrence, and mortality. Results Of 322 patients, 52 underwent PG-DTR. A matching TG group of 52 patients was selected. The PG-DTR group had smaller tumors (p = 0.02), smaller proximal and distal resection margins (p = 0.01, p < 0.01), and fewer retrieved lymph nodes (p < 0.01). PG-DTR associated with shorter times to diet and hospital stay (both p = 0.02). Groups did not differ in early (11.3 vs. 19.2%, p = 0.19), late (1.9 vs. 5.7%, p = 0.31), or severe complication rates (7.7 vs. 13.5%, p = 0.34). At 1 year, the groups did not differ in reflux symptoms (Visick score) or endoscopic esophagitis (Los Angeles Classification). There were no recurrences. Five-year overall survival rates were 100 and 81.6% (p = 0.02), respectively. Conclusion PG-DTR associated with better clinical outcomes and survival. Complication and reflux rates were similar. PG-DTR may be suitable for upper EGC.
引用
收藏
页码:516 / 524
页数:9
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