147P - Clinical outcomes of proximal gastrectomy versus total gastrectomy for locally advanced proximal gastric cancer: a propensity score matching analysis

Background

The safety and efficacy of proximal gastrectomy (PG) following for locally advanced proximal gastric cancer (LAPGC) were unclear, as oncologic outcomes of randomized trials are still pending. The aim of this study was to evaluate surgical results and long-term oncologic outcomes of PG versus total gastrectomy (TG) in treating LAGC.

Methods

A total of 2918 LAPGC patients with PG or TG were identified from the China National Cancer Center Gastric Cancer Database (NCCGCDB) 1997-2017. Propensity score matching was employed to match patients with PG or TG in a 1:1 ratio. Surgery outcomes and overall survival rates (OS) were compared between PG and TG groups after the propensity-score match. Cox proportional hazards model was used to explore the risk factors for overall survival.

Results

Of 2 918 patients, 181 (6.20%) underwent TG, while 2 737 (93.80%) underwent PG. After propensity score matching, 150 matched pairs for PG and TG were selected. Compared with TG group, PG group had shorter operative time (181.8±49.8min vs. 213.5±66.7min, P < 0.001) and less estimated blood transfusion (743.8±296.6ml vs. 978.4±421.1ml, P = 0.005). More lymph nodes (34.3±17.0 vs. 24.2±11.0, P < 0.001) were retrieved in TG group than in PG group. The 3- and 5-year OS rates (79.1% vs. 77.2% and 74.5% vs. 72.0%, respectively, both P < 0.001) in PG group were slightly higher than ones in TG group. However, the multivariable results showed that there was no significant difference in the OS status between the groups (HR = 1.17, 95% CI:0.92-1.50, P = 0.21), even stratified into stage II and III.

Conclusions

In conclusion, the extent of resection for LAPGC patients did not influence the long-term survival outcomes. Moreover, future randomized clinical trials of quality of life following PG or TG are expected to assist surgeons in choice of surgical approach and strategy for LAPGC patients.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

National Key R&D Program of China (Grant No.2017YFC0908300).

Disclosure

All authors have declared no conflicts of interest.