Comparision between Proximal Gastrectomy and Total Gastrectomy in Early Gastric Cancer

Eun Mi Kim; Hyun Yong Jeong; Eom Seok Lee; Hee Seok Moon; Jae Kyu Sung; Seok Hyun Kim; Byung Seok Lee; Seung-Moo Noh; Kyung Sang Song; Kyung Sook Shin; June-Sick Cho

doi:10.4166/kjg.2009.54.4.212

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Kim, Jeong, Lee, Moon, Sung, Kim, Lee, Noh, Song, Shin, and Cho: Comparision between Proximal Gastrectomy and Total Gastrectomy in Early Gastric Cancer

Original Article

Korean J Gastroenterol 2009;54(4):212-219.

Published online: 21 February 2009

DOI: https://doi.org/10.4166/kjg.2009.54.4.212

Comparision between Proximal Gastrectomy and Total Gastrectomy in Early Gastric Cancer

Eun Mi Kim, M.D., Hyun Yong Jeong, M.D., Eom Seok Lee, M.D., Hee Seok Moon, M.D., Jae Kyu Sung, M.D., Seok Hyun Kim, M.D., Byung Seok Lee, M.D., Seung-Moo Noh, M.D.^∗, Kyung Sang Song, M.D.^†, Kyung Sook Shin, M.D.^‡, June-Sick Cho, M.D.^‡

Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea

^∗Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea

^†Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea

^‡Department of Diagnostic Radiology, Chungnam National University College of Medicine, Daejeon, Korea

Correspondence to: Hyun Yong Jeong, M.D. Department of Internal Medicine, Chungnam National University College of Medicine, 33, Munhwa-ro, Jung-gu, Daejeon 301-721, Korea Tel: +82-42-280-7164, Fax: +82-42-254-4553 E-mail: jeonghy@cnu.ac.kr

Received 17 April 2009 Accepted 2 September 2009

Abstract

Background/Aims

The purpose of this study was to evaluate clinical outcome of proximal and total gastrectomy regarding reflux esophagitis, nutritional state, and anemia in early gastric cancer.

Methods

94 patients with early gastric cancer were included from January 2001 to January 2007 at Chungnam National University Hospital. Of whom 40 patients (31 men and 9 woman) had proximal gastrectomy (PG) and 54 patients (44 men and 10 woman) had total gastrectomy (TG). We reviewed all their medical and surgical record with surveying for gastrointestinal symptoms and reflux symptoms over the phone.

Results

There were no significant differences between basic, surgical, and histopathologic characteristics. Bile reflux symptoms and heart burn symptoms were more common and severe in the TG group. The incidences of endoscopically detected reflux esophagitis were about 60% in the TG group and about 30% in the PG group. The hemoglobin levels were significantly higher in the PG group after the operation and were gradually decreased in the TG as the time went. The levels of laboratory variables such as total protein, albumin, and total cholesterol were lower in the TG group than in the PG group after the operation. However, stoma stricture after operation developed in the PG group more often than in the TG group, and esophageal balloon dilatations were performed more frequently in the PG group.

Conclusions

PG is favorable for proximal early gastric cancer in terms of reduced reflux esophagitis, anemia, and malnutrition except the stricture at esophagogastrostomy site.

Keywords: Early gastric cancer, Proximal gastrectomy, Total gastrectomy, Reflux esophagitis, Malnutrition, Anemia

REFERENCES

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Fig. 1.

The occurrence rate of the reflux esophagitis during post-operateive follow up after proximal gastrectomy and total gastrctomy. TG, total gastrectomy; PG, proximal gastrectomy.

Fig. 2.

Change in hemoglobin, total protein, albumin, and cholesterol during postoperateive follow-up after proximal gastrectomy and total gastrctomy. TG, total gastrectomy; PG, proximal gastrectomy.

Table 1.

Comparison of Clinical and Surgical Characteristics

	PG (n=40)	TG (n=54)	p-value
Clinical characteristics
Mean age (years)	54±10	61±10	0.001
Sex ratio (M:F)	31:9	44:10	0.635
Diabetes mellitus (%)	4 (10%)	5 (9%)	0.664
Follow-up duration (months	) 47±27	40±21	0.202
Oral 5-FU therapy (%)	20 (50%)	29 (54%)	) 0.652
Surgical characteristics
Operation time (minutes)	187±35	191±42	0.664
IV duration (duration)	7.3±5.7	6.0±1.9	0.179
Splenectomy	1 (3%)	2 (4%)	0.642
Post-operative complication
Surgical site infection	0 (0%)	0 (0%)
Intraabdominal abscess	4 (10%)	1 (2%)	0.199
Post operative bleeding	0 (0%)	1 (2%)
Anastomosis leakage	0 (0%)	0 (0%)

PG, proximal gastrectomy; TG, total gastrectomy.

Table 2.

Comparison of Pathological Characteristics

	PG (n=40)	TG (n=54)	p-value
Tumor depth			0.644
Mucosa	17 (43%)	25 (46%)
Submucosa	23 (57%)	29 (54%)
LN metastasis			0.690
Yes	5 (12%)	8 (15%)
No	35 (88%)	46 (85%)
Lymphovascular invasion			0.321
Yes	12 (30%)	23 (43%)
No	28 (70%)	31 (57%)
Histologic grade			0.649
Well differentiated	5 (12%)	6 (11%)
Moderately differentiated	16 (40%)	22 (41%)
Poorly differentiated	14 (35%)	20 (37%)
Mucinous	1 (3%)	1 (2%)
Signet ring cell	4 (10%)	5 (9%)

PG, proximal gastrectomy; TG, total gastrectomy; LN, lymph node.

Table 3.

Comparison of Gastrointestinal Symptom, Reflux Symptom, Food Intake, and Body Weight Loss

	PG (n=37)	TG (n=44)	p-value
Gastrointestinal symptom
Abdominal discomfort	12 (32%)	17 (39%)	0.645
Nausea	7 (19%)	7 (16%)	0.721
Vomitig	12 (32%)	11 (25%)	0.460
Dyspepsia	6 (16%)	7 (16%)	0.970
Diarrhea	15 (41%)	17 (39%)	0.861
Constipation	6 (16%)	15 (34%)	0.057
Reflux symptom
Bile reflux	21 (57%)	39 (87%)	0.009
Regurgitation of meal	16 (43%)	7 (16%)	0.006
Heart burn	13 (35%)	33 (75%)	0.003
Medication for reflux	22 (55%)	42 (78%)	0.026
symptom
Food intake (%)	52±18%	60±27%	0.126
Frequency of daily meals	2.9±0.5	3.3±0.6	0.004
Body weight loss (%)	12.9±8.8%	21.2±8.9%	0.033

PG, proximal gastrectomy; TG, total gastrectomy.

Table 4.

Comparison of Reflux Esophagitis 2 Years after Proximal Gastrectomy and Total Gastrctomy

	PG (n=29)	TG (n=50) p-value
Reflux esophagitis	s	0.013
O, A, B	28 (97%)	37 (74%)
C, D	1 (3%)	13 (26%)

PG, proximal gastrectomy; TG, total gastrectomy.

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