[Clinical efficacy and safety of totally laparoscopic subtotal gastrectomy with cardia-gastric fundus preservation in middle-upper gastric cancer].

[OBJECTIVE] To investigate the clinical efficacy and safety of totally laparoscopic radical subtotal gastrectomy with preservation of the cardia and partial gastric fundus in the treatment of middle-upper gastric cancer.

[METHODS] A retrospective cohort study was conducted on 41 patients with middle and upper gastric cancer admitted to Fudan University Shanghai Cancer Center from January to June 2025. The patients were divided into an observation group (=21) and a control group (=20) according to the surgical method. The observation group underwent totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation, while the control group received laparoscopic total gastrectomy. Perioperative surgical indicators, postoperative recovery, complications, pathological results, and follow-up data on nutritional status were observed and compared between the two groups.

[RESULTS] All patients in both groups successfully completed the surgery without conversion to open surgery or surgical modification during the operation. The average total operative time in the observation group was (156.1±14.2) min, which was significantly shorter than (169.8±6.7) min in the control group ( < 0.05). There were no significant differences in the time of digestive tract reconstruction and intraoperative blood loss between the two groups (>0.05). The average time to first oral water intake, first liquid diet intake and postoperative hospital stay in the observation group were (2.1±0.4) d, (3.4±0.5) d and (6.3±0.5) d, respectively, all significantly shorter than those in the control group (2.9±0.6) d, (3.9±0.5) days and (7.1±1.0) d, all < 0.05. No perioperative complications such as anastomotic leakage or postoperative bleeding occurred in either group. Pathological results showed no significant differences in postoperative pathological stage and number of dissected lymph nodes between the two groups (>0.05). No tumor recurrence or metastasis was identified during the postoperative follow-up period.The proportion of patients with decreased body mass index (BMI) compared with preoperative level in the observation group was 23.8%, which was significantly lower than 50.0% in the control group (=0.046). The serum vitamin B12 level in the observation group 3 months after surgery was (416.0±145.3) ng/L, significantly higher than (315.0±128.2) ng/L in the control group (=0.026).

[CONCLUSION] Totally laparoscopic radical subtotal gastrectomy with cardia and partial fundus preservation can ensure the radicality of tumor resection for middle and upper gastric cancer. Compared with laparoscopic total gastrectomy, it has the advantages of shorter operative time, faster postoperative recovery, better maintenance of postoperative nutritional status and quality of life in patients, with reliable safety. It may serve as a novel individualized therapeutic option for patients with middle and upper gastric cancer.