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


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2019-04-01

AUTHORS

Hyo Jung Ko, Ki Hyun Kim, Si-Hak Lee, Cheol Woong Choi, Su Jin Kim, Chang In Choi, Dae-Hwan Kim, Dong-Heon Kim, Sun-Hwi Hwang

ABSTRACT

BackgroundThis 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.MethodsAll 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.ResultsOf 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.ConclusionPG-DTR associated with better clinical outcomes and survival. Complication and reflux rates were similar. PG-DTR may be suitable for upper EGC. More... »

PAGES

516-524

References to SciGraph publications

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  • 2013-09-20. Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer in GASTRIC CANCER
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    26 schema:description BackgroundThis 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.MethodsAll 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.ResultsOf 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.ConclusionPG-DTR associated with better clinical outcomes and survival. Complication and reflux rates were similar. PG-DTR may be suitable for upper EGC.
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    34 BackgroundThis retrospective cohort study
    35 ConclusionPG-DTR
    36 MethodsAll consecutive patients
    37 PG-DTR
    38 PG-DTR group
    39 PG-DTR patients
    40 Reconstruction Replace Total Gastrectomy
    41 Replace Total Gastrectomy
    42 ResultsOf 322 patients
    43 Roux
    44 TG group
    45 TG patients
    46 Tract Reconstruction Replace Total Gastrectomy
    47 age
    48 analysis
    49 better clinical outcomes
    50 body mass index
    51 cancer
    52 characteristics
    53 clinical outcomes
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    55 clinicopathological characteristics
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    66 five-year overall survival rate
    67 gastrectomy
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    71 index
    72 lymph nodes
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    74 mass index
    75 matching TG group
    76 morbidity
    77 mortality
    78 nodes
    79 outcomes
    80 overall survival rate
    81 patients
    82 postoperative complications
    83 propensity score
    84 proximal gastrectomy
    85 rate
    86 reconstruction
    87 recurrence
    88 reflux morbidity
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    95 severe postoperative complications
    96 sex
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