Effect of Laparoscopic Proximal Gastrectomy With Double-Tract Reconstruction vs Total Gastrectomy on Hemoglobin Level and Vitamin B12 Supplementation in Upper-Third Early Gastric Cancer

JAMA Network Open
Q1
Feb 2023
Citations:67
Influential Citations:2
Interventional (Human) Studies
81
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Enhanced Details

Methods
Open-label multicenter superiority randomized clinical trial at 10 Korean institutions; 138 adults with upper-third cT1N0M0 gastric cancer; mean age 60.0 years (SD 10.9); 87 men; all Asian; randomized 1:1 to LPG-DTR or LTG; follow-up up to 24 months; primary endpoints: change in hemoglobin level and cumulative vitamin B12 supplementation at 2 years.
Intervention
Vitamin B12 supplementation management post-surgery: intramuscular injections of vitamin B12 (1 mg/2 mL) given as needed when B12 falls below 200 pg/mL; some oral supplementation used; duration up to 24 months.
Results
Vitamin B12 supplementation over 2 years was significantly lower after LPG-DTR than LTG (0.4 mg vs 2.5 mg; difference 2.1 mg; P<0.001). Hemoglobin change at 2 years was not significantly different (−5.6% vs −6.9%; difference −1.3%; P=0.35). Reflux esophagitis incidence was similar (2.9% in both groups); 2-year overall survival 98.5% vs 100% and disease-free survival 98.5% vs 97.1% (no significant differences). LPG-DTR yielded better physical functioning (85.2 vs 79.9) and social functioning (89.5 vs 82.4) on QoL assessments. Conclusion: LPG-DTR may be as safe as LTG and may preserve function while reducing the need for vitamin B12 supplementation; Hb change similar between groups; QoL advantages observed with LPG-DTR.
Limitations
2-year follow-up only; QoL not the primary endpoint; iron supplementation not accounted for Hb changes; conducted in Korea, which may limit generalizability; relatively small sample (n=138).

Abstract

Key Points Question Is laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DTR) superior to laparoscopic total gastrectomy (LTG) for the treatment of patients with clinically early gastric cancer (GC) in the upper third of the sto...