Clinical outcome of proximal versus total gastrectomy for proximal gastric cancer

Tumors in the upper one-third of the stomach has been increasing. Although the standard operation for proximal gastric cancer has been total gastrectomy, some have used proximal gastrectomy, reconstructed by jejunum or gastric tube. The aim of this study was to evaluate the surgical results, hospital costs, and quality of life after gastrectomy for cancer. A consecutive series of 51 patients with stage I or II proximal gastric cancer was studied: 14 underwent proximal gastrectomy reconstructed by gastric tube (direct anastomosis between esophagus and remnant of tube-like stomach), 17 proximal gastrectomy reconstructed by jejunum, and 20 total gastrectomy in Roux-en-Y fashion. Quality of life was estimated by a 24-item questionnaire with a scoring system of 1 to 3, and hospital costs covered all charges during the hospital stay. Operating time, blood loss, and hospital stay for the gastric tube group were less than those for the jejunum group or the total gastrectomy group. Hospital charges for the gastric tube group were lower than those for the jejunum group or the total gastrectomy group (141 X 10(4) yen, 179 X 10(4) yen, 211 X 10(4) yen, respectively). Although the total score for quality of life was not significantly different among the three groups (35.9, 39.5, 37.6), the number of meals per day was less and the performance status was better in the gastric tube group. Jejunal interposition was less favorably, accepted by the patients as a good operation they would recommend to others. The results indicate that, in patients with proximal gastric cancer, proximal gastrectomy reconstructed by gastric tube provides a shorter operating time, earlier recovery, lower hospital charge, and better performance status when compared with proximal gastrectomy reconstructed with jejunum or total gastrectomy.