Is proximal gastrectomy superior to total gastrectomy for proximal gastric carcinoma?

Analysis of lymph node metastasis in 100 patients with proximal gastric cancer who underwent curative total gastrectomy revealed that spread to the peripyloric nodes, which cannot be dissected adequately in proximal gastrectomy, docs not occur before serosal invasion. Thus 28 patients who underwent proximal gastrectomy and 25 who underwent total gastrectomy for early cancer of the proximal stomach were compared to determine whether proximal or total gastrectomy is superior in treatment. No difference in the length of operation, operative blood loss or postoperative complications, including anastomotic leakage, was observed. However, the metabolic consequences of gastric resection in the two groups were similar, as determined by changes in body weight, serum hemoglobin and total serum protein concentrations. Diarrhea (32%) and reflux (28%) were more common following proximal gastrectomy, and postprandial fullness (21%) following total gastrectomy. Available evidence does not support the claim that proximal gastrectomy is superior because of physiologic advantages accrued by retaining a gastric remnant.