Cancer Res Treat.  2025 Jan;57(1):174-185. 10.4143/crt.2024.319.

Proximal Gastrectomy Is Associated with Lower Incidence of Anemia and Vitamin B12 Deficiency Compared to Total Gastrectomy in Patients with Upper Gastric Cancer

• Song JH
• Park SH
• Cho M
• Kim YM
• Hyung WJ
• Kim HI

• KMID: 2564592
• DOI: http://doi.org/10.4143/crt.2024.319

Abstract

Purpose
Proximal gastrectomy is an alternative to total gastrectomy (TG) for early gastric cancer (EGC) treatment in the upper stomach. However, its benefits in terms of perioperative and long-term outcomes remain controversial. The aim of this study was to compare the perioperative, body compositional, nutritional, and survival outcomes of patients undergoing proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG for pathological stage I gastric cancer in upper stomach.
Materials and Methods
The study included 506 patients who underwent gastrectomy for pathological stage I gastric cancer in the upper stomach between 2015 and 2019. Clinicopathological, perioperative, body compositional, nutritional, and survival outcomes were compared between the PG-DTR and TG groups.
Results
The PG-DTR and TG groups included 197 (38.9%) and 309 (61.1%) patients, respectively. The PG-DTR group had a lower rate of early complications (p=0.041), lower diagnosis rate of anemia and vitamin B12 deficiency (all p < 0.001), and lower replacement rate of iron and vitamin B12 compared to TG group (all p < 0.001). The PG-DTR group showed reduced incidence of sarcopenia at 6-months postoperatively, preserved higher amount of visceral fat after surgery (p=0.032 and p=0.040, respectively), and showed a higher hemoglobin level (p=0.007). Oncologic outcomes were comparable between the groups.
Conclusion
The PG-DTR for EGC located in the upper stomach offered advantages of fewer complications, lower incidence of anemia and vitamin B12 deficiency, less decrease in visceral fat volume, and similar survival compared to TG. Consequently, PG-DTR may be considered a superior alternative treatment option to TG.

Keyword

Stomach neoplasms; Proximal gastrectomy; Total gastrectomy; Vitamin B12 deficiency; Anemia

Figure

• 

  Fig. 1. The 5-year cumulative incidences of anemia and vitamin B12 deficiency and their respective replacements in the two study groups. (A) 5-Year cumulative incidence of anemia. (B) 5-Year cumulative incidence of iron replacement. (C) Frequency of iron replacement. (D) 5-Year cumulative incidence of vitamin B12-deficiency. (E) 5-Year cumulative incidence of vitamin B12 replacement. (F) Frequency of vitamin B12 replacement. PG-DTR, proximal gastrectomy with double-tract reconstruction; TG, total gastrectomy.

• 

  Fig. 2. Changes in body composition and nutritional laboratory values in the two study groups. (A) Visceral fat volume. (B) Subcutaneous fat volume. (C) Muscle volume. (D) Abdominal circumference. (E) Body weight. (F) Hemoglobin. (G) Albumin. (H) Prognostic nutritional index. *p < 0.05.

• 

  Fig. 3. Overall and recurrence-free survivals of the patients between the two study groups. (A) Overall survivals. (B) Recurrence-free survivals. PG-DTR, proximal gastrectomy with double-tract reconstruction; TG, total gastrectomy.

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