Comparison of long-term outcomes between proximal gastrectomy and total gastrectomy for advanced gastric cancer in the upper third of the stomach: a propensity score-matched analysis

Yosuke Kano; Hiroshi Ichikawa; Yusuke Muneoka; Kazuaki Kobayashi; Shirou Kuwabara; Shigeto Makino; Yasuyuki Kawachi; Masaki Aizawa; Satoru Nakagawa; Takaaki Hanyu; Tomoyuki Kakuta; Kenji Usui; Tetsuya Naito; Yoshifumi Shimada; Jun Sakata; Toshifumi Wakai

doi:10.1093/jjco/hyag010

Comparison of long-term outcomes between proximal gastrectomy and total gastrectomy for advanced gastric cancer in the upper third of the stomach: a propensity score-matched analysis

Jpn J Clin Oncol. 2026 Feb 3:hyag010. doi: 10.1093/jjco/hyag010. Online ahead of print.

Authors

Affiliations

¹ Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan.
² Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata 950-1197, Japan.
³ Department of Surgery, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka City, Niigata 940-0861, Japan.
⁴ Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-cho, Chuo-ku, Niigata City, Niigata 951-8566, Japan.
⁵ Department of Surgery, Niigata Prefectural Shibata Hospital, 1-2-8 Hon-cho, Shibata City, Niigata 957-8588, Japan.
⁶ Division of Digestive and General Surgery, Japanese Red Cross Nagaoka Hospital, 2-297-1 Senshu, Nagaoka City, Niigata 940-2085, Japan.

PMID: 41632509
DOI: 10.1093/jjco/hyag010

Abstract

Background: Total gastrectomy (TG) is commonly performed as the standard treatment for upper third advanced gastric cancer (AGC). Proximal gastrectomy (PG) may be a potential alternative procedure for upper-third AGC. However, its oncologic safety remains uncertain. This study aimed to compare the long-term outcomes of PG and TG for upper-third AGC and to evaluate the oncological safety of PG.

Methods: We retrospectively analyzed the data of patients who underwent PG or TG for clinical T2-T4aNanyM0 upper-third gastric cancer at six institutions between 2018 and 2022. To minimize selection bias, propensity score matching (PSM) was performed at a 1:1 ratio. The primary endpoint was overall survival (OS).

Results: A total of 208 patients with upper-third AGC were included. After PSM, 104 patients were selected for analysis, with 52 patients in each group. The 3-year OS rates were 81.8% in the PG group and 70.8% in the TG group, with no statistically significant difference between the two groups (P = .167), with a hazard ratio for PG of 0.58 (95% confidence interval, 0.27-1.27; P = .173). Subgroup analysis revealed that the hazard ratio for OS was significantly lower in the PG group than in the TG group among patients with tumor diameters <50 mm.

Conclusions: The long-term survival outcomes of PG and TG for upper-third AGC patients are comparable, suggesting that PG may be an oncologically acceptable option in carefully selected patients.

Keywords: advanced gastric cancer; long-term survival; propensity score matching; proximal gastrectomy; upper third of the stomach.

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