Abstract：
BACKGROUND: Surgical procedures for proximal gastric cancer remain a highly debated topic. Total gastrectomy (TG) is widely accepted as a standard radical surgery. However, subtotal esophagectomy, proximal gastrectomy (PG) or even subtotal gastrectomy, when a small upper portion of the stomach can technically be preserved, are alternatives in current clinical practice.
METHODS: Using a cohort of the PGSAS NEXT trial, consisting of 1909 patients responding to a questionnaire sent to 70 institutions between July 2018 and December 2019, gastrectomy type, reconstruction method, and furthermore the remnant stomach size and the anti-reflux procedures for PG were evaluated.
RESULTS: TG was the procedure most commonly performed (63.0%), followed by PG (33.4%). Roux-en-Y was preferentially employed following TG irrespective of esophageal tumor invasion, while jejunal pouch was adopted in 8.5% of cases with an abdominal esophageal stump. Esophagogastrostomy was most commonly selected after PG, followed by the double-tract method. The former was preferentially employed for larger remnant stomachs (≧3/4), while being used slightly less often for tumors with as compared to those without esophageal invasion in cases with a remnant stomach 2/3 the size of the original stomach. Application of the double-tract method gradually increased as the remnant stomach size decreased. Anti-reflux procedures following esophagogastrostomy varied markedly.
CONCLUSIONS: TG is the mainstream and PG remains an alternative in current Japanese clinical practice for proximal gastric cancer. Remnant stomach size and esophageal stump location appear to influence the choice of reconstruction method following PG.
METHODS: Using a cohort of the PGSAS NEXT trial, consisting of 1909 patients responding to a questionnaire sent to 70 institutions between July 2018 and December 2019, gastrectomy type, reconstruction method, and furthermore the remnant stomach size and the anti-reflux procedures for PG were evaluated.
RESULTS: TG was the procedure most commonly performed (63.0%), followed by PG (33.4%). Roux-en-Y was preferentially employed following TG irrespective of esophageal tumor invasion, while jejunal pouch was adopted in 8.5% of cases with an abdominal esophageal stump. Esophagogastrostomy was most commonly selected after PG, followed by the double-tract method. The former was preferentially employed for larger remnant stomachs (≧3/4), while being used slightly less often for tumors with as compared to those without esophageal invasion in cases with a remnant stomach 2/3 the size of the original stomach. Application of the double-tract method gradually increased as the remnant stomach size decreased. Anti-reflux procedures following esophagogastrostomy varied markedly.
CONCLUSIONS: TG is the mainstream and PG remains an alternative in current Japanese clinical practice for proximal gastric cancer. Remnant stomach size and esophageal stump location appear to influence the choice of reconstruction method following PG.
摘要：
背景：近端胃癌的外科手术仍是一个备受争议的话题。全胃切除术（TG）被广泛接受为标准的根治性手术。然而,食管次全切除术,近端胃切除术（PG）甚至胃大部切除术，当胃的一小部分在技术上可以被保存时，是当前临床实践中的替代方案。
方法：使用PGSASNEXT试验的队列，由1909名患者组成，对2018年7月至2019年12月期间发送到70个机构的调查问卷做出回应，胃切除术类型，重建方法,此外，还评估了残余胃的大小和PG的抗反流程序。
结果：TG是最常见的程序（63.0％），其次是PG(33.4%)。无论食管肿瘤侵袭如何，TG后优先使用Roux-en-Y，而空肠袋在8.5%的腹部食管残端病例中被采用。食管胃造口术最常见于PG后，其次是双道法。前者优先用于较大的残余胃(≥3/4)，在残胃2/3大小的情况下，与没有食道侵袭的肿瘤相比，肿瘤的使用频率略低。随着残胃大小的减小，双道法的应用逐渐增加。食管胃造口术后的抗反流程序差异显着。
结论：在目前的日本近端胃癌临床实践中，TG是主流，PG仍然是一种替代方法。剩余的胃大小和食管残端位置似乎会影响PG后重建方法的选择。
方法：使用PGSASNEXT试验的队列，由1909名患者组成，对2018年7月至2019年12月期间发送到70个机构的调查问卷做出回应，胃切除术类型，重建方法,此外，还评估了残余胃的大小和PG的抗反流程序。
结果：TG是最常见的程序（63.0％），其次是PG(33.4%)。无论食管肿瘤侵袭如何，TG后优先使用Roux-en-Y，而空肠袋在8.5%的腹部食管残端病例中被采用。食管胃造口术最常见于PG后，其次是双道法。前者优先用于较大的残余胃(≥3/4)，在残胃2/3大小的情况下，与没有食道侵袭的肿瘤相比，肿瘤的使用频率略低。随着残胃大小的减小，双道法的应用逐渐增加。食管胃造口术后的抗反流程序差异显着。
结论：在目前的日本近端胃癌临床实践中，TG是主流，PG仍然是一种替代方法。剩余的胃大小和食管残端位置似乎会影响PG后重建方法的选择。
