Comparison of long-term outcomes between proximal gastrectomy and total gastrectomy for advanced gastric cancer in the upper third of the stomach: a propensity score-matched analysis

Background Total gastrectomy (TG) is commonly performed as the standard treatment for upper third advanced gastric cancer (AGC). Proximal gastrectomy (PG) may be a potential alternative procedure for upper-third AGC. However, its oncologic safety remains uncertain. This study aimed to compare the long-term outcomes of PG and TG for upper-third AGC and to evaluate the oncological safety of PG. Methods We retrospectively analyzed the data of patients who underwent PG or TG for clinical T2–T4aNanyM0 upper-third gastric cancer at six institutions between 2018 and 2022. To minimize selection bias, propensity score matching (PSM) was performed at a 1:1 ratio. The primary endpoint was overall survival (OS). Results A total of 208 patients with upper-third AGC were included. After PSM, 104 patients were selected for analysis, with 52 patients in each group. The 3-year OS rates were 81.8% in the PG group and 70.8% in the TG group, with no statistically significant difference between the two groups (P = .167), with a hazard ratio for PG of 0.58 (95% confidence interval, 0.27–1.27; P = .173). Subgroup analysis revealed that the hazard ratio for OS was significantly lower in the PG group than in the TG group among patients with tumor diameters <50 mm. Conclusions The long-term survival outcomes of PG and TG for upper-third AGC patients are comparable, suggesting that PG may be an oncologically acceptable option in carefully selected patients.