Pathologic Staging and Selection Appropriateness of Proximal Gastrectomy with Double-Tract Reconstruction Compared to Total Gastrectomy in Localized Proximal Gastric Cancer

Proximal gastric cancer presents unique surgical challenges due to its anatomical location and the need to balance adequate resection with functional preservation. While total gastrectomy (TG) has traditionally been the standard surgical approach, proximal gastrectomy with double-tract reconstruction (PG-DTR) has emerged as a function-preserving alternative for selected patients. However, concerns remain regarding appropriate patient selection and pathological staging when proximal gastrectomy with double-tract reconstruction is used. This single-center retrospective cohort study included adult patients who underwent curative-intent surgery for localized proximal gastric adenocarcinoma between 2010 and 2022. Primary endpoints were the distribution of pathological tumor depth (pT stage). Patients were treated with either total gastrectomy or proximal gastrectomy with double-tract reconstruction. Group comparisons were performed using appropriate statistical tests. A total of 60 patients were included, with 30 patients in each surgical group. The overall cohort consisted predominantly of patients with localized disease (T1–T3), with no cases of T4 tumors identified. Pathological T-stage distribution did not differ significantly between the proximal gastrectomy with double-tract reconstruction and total gastrectomy groups (overall p = 0.054), although a trend toward higher T2–T3 stages was observed in the proximal gastrectomy with double-tract reconstruction group. No clinically significant anastomotic complications requiring intervention were observed in either group during follow-up. In this single-center retrospective analysis, proximal gastrectomy with double-tract reconstruction was applied in patients with localized proximal gastric cancer without apparent compromise in pathological staging appropriateness. While total gastrectomy remains the standard approach for advanced disease, proximal gastrectomy with double-tract reconstruction may represent a feasible surgical option in carefully selected patients. Prospective studies with comprehensive long-term follow-up are warranted to better define comparative outcomes between procedures.