Background:Proximal gastrectomy (PG) with double tract reconstruction (DTR) offers organ preservation for early gastric cancers, leading to reduced vitamin B12 deficiency, less weight loss, and improved quality of life. The JCOG1401 study confirmed excellent long-term outcomes for PG in stage I gastric cancer. However, in locally advanced proximal gastric cancer (LAPGC), preserving the gastric body and lymph node station 4d may compromise margin clearance and adequate lymphadenectomy.Methods: We propose a modified PG that removes the distal esophagus, gastroesophageal junction (GEJ), cardia, fundus, and gastric body, preserving only the antrum and performing DTR. Lymphadenectomy is also adapted, removing stations 1, 2, 3a, 4sa, 4sb, 4d, 7, 8, 9, 10 (spleen preserving), 11, and lower mediastinal nodes (stations 19, 20, and 110), while preserving stations 3b, 5, and 6. Indications for this procedure include GEJ (Siewert type II and III) and proximal gastric cancers with ≤2 cm distal esophageal involvement and ≤5 cm gastric involvement.Results:In our initial experience with 14 patients, we achieved R0 resection in all patients, adequate lymph node harvest (median 24 nodes, IQR 18–38), and no locoregional recurrences at a median follow-up of 18 months. We also found favorable postoperative weight loss, reflux, and anemia in the PG cohort.Conclusion:While larger studies and long-term data are still needed, our early results suggest that modified PG—despite sparing only the antrum—retains the key benefits of PG over total gastrectomy, including better weight maintenance and improved hemoglobin levels, while maintaining oncologic outcomes for LAPGC.
背景：近端胃切除术（PG）联合双通道重建（DTR）为早期胃癌提供了器官保留方案，可减少维生素B12缺乏、减轻体重下降并改善生活质量。JCOG1401研究证实了PG在I期胃癌中具有优异的长期预后。然而，对于局部进展期近端胃癌（LAPGC），保留胃体和4d组淋巴结可能影响切缘清除和淋巴结清扫的彻底性。 方法：我们提出一种改良PG术式，切除远端食管、胃食管结合部（GEJ）、贲门、胃底及胃体，仅保留胃窦并行DTR。淋巴结清扫范围相应调整：清扫第1、2、3a、4sa、4sb、4d、7、8、9、10（保脾）、11组及下纵隔淋巴结（第19、20、110组），同时保留第3b、5、6组淋巴结。该术式适应症包括GEJ癌（Siewert II型和III型）及近端胃癌，要求食管侵犯≤2 cm且胃侵犯≤5 cm。 结果：在初期14例患者中，所有患者均实现R0切除，淋巴结获取充分（中位数24枚，四分位距18-38枚），中位随访18个月无局部区域复发。PG组患者术后体重下降、反流及贫血情况均表现良好。 结论：虽然仍需更大规模研究和长期数据支持，但我们的早期结果表明，改良PG术式尽管仅保留胃窦，仍能维持PG相对于全胃切除术的核心优势，包括更好的体重维持和血红蛋白水平改善，同时在LAPGC治疗中保持了肿瘤学疗效。
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