Does proximal gastrectomy work better versus total gastrectomy in proximal gastric cancers? A Comparative analytic study

Background and aim: The ideal extent of resection in proximal gastric cancer is still controversial and there is no general consensus. Therefore, this study was designed to compare the results of proximal gastrectomy versus total gastrectomy in patients with proximal gastric cancer. Methods: One hundred forty-six patients who underwent total (n=96) or proximal (n=50) gastrectomy due to proximal gastric cancer in Firoozgar Hospital, in Tehran, Iran in 2015 and 2021 were enrolled. Patients were classified and evaluated according to age, sex, duration of hospitalization, 30-day mortality, histological grading and stage, resection margin, lymph node involvement, and overall survival. Results: Patients who underwent proximal gastrectomy had a significantly longer survival (P=0.025). There was no statistically significant difference between the two groups in terms of the number of lymph nodes removed and the status of resected margin. Cox regression analysis showed that the number of positive lymph nodes, undergoing splenectomy and grade of invasion were associated with decreased survival (P<0.05). Conclusion: The optimal treatment for proximal gastric cancer is not yet known. Although patients with proximal gastric cancer who underwent proximal gastrectomy had better survival, it might be due to the confounding effect of a grade of invasion, which needs further investigations in this field.