Scholarlink

Background <p>Total gastrectomy (TG) remains the standard surgical approach for proximal gastric and gastroesophageal junction (P/GEJ) cancers. However, experts increasingly perform proximal gastrectomy (PG) with anti-reflux reconstruction. The benefits of minimally invasive PG (MIPG) over minimally invasive TG (MITG), particularly regarding postoperative quality of life (QoL), remain unclear.</p> Methods <p>We conducted a transpacific, multicenter, nonrandomized, prospective cohort study to compare symptom burden outcomes (symptom occurrence, symptom severity, and daily functioning) between MIPG and MITG in patients with P/GEJ cancers. Symptom burden data was collected using the MD Anderson Symptom Inventory (MDASI-GI +).</p> Results <p>Among 71 patients with P/GEJ cancers enrolled from 2022 through 2024, 64 underwent either MITG (<i>n</i> = 26, 41%) or MIPG (<i>n</i> = 38, 59%). Thirty-nine (61%) patients were treated at Asian centers, and 25 (39%) patients were treated at U.S. centers. Compared to the MIPG patients, the MITG patients had a larger mean tumor size (5.7 vs. 2.3&#xa0;cm) and a higher prevalence of signet ring cell histology (50 vs. 18%). Operation times were comparable between the MITG and MIPG groups (median: 288.5 vs. 277.0&#xa0;min), as were the rates of postoperative complications (19 vs. 24%), anastomotic leaks (0 vs. 3%), 90-day mortality (0 vs. 3%), and positive proximal margins (8 vs. 0%, all <i>p</i> &gt; 0.05). QoL data (MDASI-GI +) were collected from at least 95% of patients at all time points. Key metrics related to QoL—appetite, reflux, total symptom burden, and functional interference—did not differ significantly between groups at 1 and 3&#xa0;months postoperatively. A linear mixed-effects model showed that body-weight trajectories over time did not differ significantly between the MITG and MIPG groups, and there was no significant difference between their highest weight loss percentages within the first 3&#xa0;months postoperatively. At postoperative month 3, hemoglobin, albumin, vitamin B12, and ghrelin levels were comparable between the groups.</p> Conclusion <p>MIPG and MITG demonstrated equivalent short-term safety, and MIPG did not confer measurable QoL advantages, including in appetite, within 3&#xa0;months after surgery. Longer-term follow-up is ongoing to evaluate potential delayed advantages.</p> <p><b>Trial registration number:</b> On January 11, 2022, this trial was registered with the Clinical Trials Reporting Program under the registration number NCI-2022-00267 and with ClinicalTrials.gov under the registration number NCT05205343.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Transpacific multicenter collaborative study of minimally invasive proximal gastrectomy vs. minimally invasive total gastrectomy for proximal gastric and gastroesophageal junction cancers: 3-month follow-up results

  • 期刊论文

  • 发表日期：

    2025年9月29日

查看全文
  • Naruhiko Ikoma,
  • Travis Grotz,
  • Hirofumi Kawakubo,
  • Hyoung-Il Kim,
  • Satoru Matsuda,
  • Jun Okui,
  • Koichi Tomita,
  • Yuki Hirata,
  • Atsushi Nakao,
  • Loretta A. Williams,
  • Xin Shelley Wang,
  • Xuemei Wang,
  • Paul F. Mansfield,
  • Woo-Jin Hyung,
  • Brian D. Badgwell,
  • Vivian E. Strong,
  • Yuko Kitagawa

摘要

Background

Total gastrectomy (TG) remains the standard surgical approach for proximal gastric and gastroesophageal junction (P/GEJ) cancers. However, experts increasingly perform proximal gastrectomy (PG) with anti-reflux reconstruction. The benefits of minimally invasive PG (MIPG) over minimally invasive TG (MITG), particularly regarding postoperative quality of life (QoL), remain unclear.

Methods

We conducted a transpacific, multicenter, nonrandomized, prospective cohort study to compare symptom burden outcomes (symptom occurrence, symptom severity, and daily functioning) between MIPG and MITG in patients with P/GEJ cancers. Symptom burden data was collected using the MD Anderson Symptom Inventory (MDASI-GI +).

Results

Among 71 patients with P/GEJ cancers enrolled from 2022 through 2024, 64 underwent either MITG (n = 26, 41%) or MIPG (n = 38, 59%). Thirty-nine (61%) patients were treated at Asian centers, and 25 (39%) patients were treated at U.S. centers. Compared to the MIPG patients, the MITG patients had a larger mean tumor size (5.7 vs. 2.3 cm) and a higher prevalence of signet ring cell histology (50 vs. 18%). Operation times were comparable between the MITG and MIPG groups (median: 288.5 vs. 277.0 min), as were the rates of postoperative complications (19 vs. 24%), anastomotic leaks (0 vs. 3%), 90-day mortality (0 vs. 3%), and positive proximal margins (8 vs. 0%, all p > 0.05). QoL data (MDASI-GI +) were collected from at least 95% of patients at all time points. Key metrics related to QoL—appetite, reflux, total symptom burden, and functional interference—did not differ significantly between groups at 1 and 3 months postoperatively. A linear mixed-effects model showed that body-weight trajectories over time did not differ significantly between the MITG and MIPG groups, and there was no significant difference between their highest weight loss percentages within the first 3 months postoperatively. At postoperative month 3, hemoglobin, albumin, vitamin B12, and ghrelin levels were comparable between the groups.

Conclusion

MIPG and MITG demonstrated equivalent short-term safety, and MIPG did not confer measurable QoL advantages, including in appetite, within 3 months after surgery. Longer-term follow-up is ongoing to evaluate potential delayed advantages.

Trial registration number: On January 11, 2022, this trial was registered with the Clinical Trials Reporting Program under the registration number NCI-2022-00267 and with ClinicalTrials.gov under the registration number NCT05205343.