ArticleJournal of gastric cancer2025
Is Proximal Gastrectomy Oncologically Justifiable for Advanced Siewert II/III Adenocarcinoma of the Esophagogastric Junction?
Article in Journal of gastric cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Survival Comparison of Proximal and Total Gastrectomy after Neoadjuvant Therapy in Siewert Type II/III Gastric Adenocarcinoma: A Real-World Multicenter Cohort Study.Annals of surgical oncology · 2026Article
- Neoadjuvant therapy reshapes the therapeutic value of distal lymphadenectomy in cT3/4a proximal gastric cancer.Science China. Life sciences · 2026Article
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Authors and funding
8 authors.
Funding
Abstract
purposeThe oncological safety of proximal gastrectomy (PG) for advanced Siewert II/III adenocarcinoma of the esophagogastric junction (AEG) remains controversial. We compared the long-term oncological outcomes of PG and total gastrectomy (TG) to refine the indications for PG. MATERIALS AND
methodsThis dual-center retrospective study included 443 patients with pT2-4NanyM0 Siewert II/III AEG who underwent PG (n=192) or TG (n=251). Propensity score matching yielded 149 matched pairs. Perioperative outcomes, overall survival (OS), recurrence-free survival (RFS), and recurrence patterns were analyzed. Logistic regression analysis was used to assess risk factors for perigastric lymph nodes (PLN) recurrence after PG and key distal lymph nodes (KDLN) metastases after TG. The therapeutic index (TI) of KDLN metastases was calculated.
resultsAlthough survival rates were lower after PG, no significant differences were observed in OS (hazard ratio [HR],1.39; P=0.109) or RFS (HR, 1.30; P=0.212). PG was associated with more local recurrences (24.12% vs. 8.7%; P<0.001), especially PLN metastases (13.4% vs. 5.4%; P=0.023). In subgroup analyses, PG was associated with worse OS in pT4 patients (HR, 2.17; P=0.006) and worse RFS in pN3 patients (HR, 2.37; P=0.011). In patients who underwent TG, tumor size >6 cm (OR, 3.72) and pT4 (OR, 13.9) predicted KDLN metastasis. Patients with KDLN metastases had significantly worse OS (HR, 2.51; P<0.001).
conclusionsTG is more suitable for patients with advanced Siewert II/III AEG with pT4, tumors >6 cm, or those with a high predicted risk of KDLN metastases. Accurate preoperative staging and intraoperative reassessment are essential for safe PG selection.
trial registrationChinese Clinical Trial Registry Identifier: ChiCTR2500102562.
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