ORIGINAL ARTICLE Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary Pavan Sugoor 1 & Sanket Shah 1 & Rohit Dusane 1 & Ashwin Desouza 1 & Mahesh Goel 1 & Shailesh V. Shrikhande 1 Received: 17 April 2015 /Accepted: 30 March 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Background The appropriate extent of gastric resection for patients with proximal third gastric cancer is controversial. This study addresses whether the choice of surgical strategy (proximal gastrectomy [PG] versus total gastrectomy [TG]) influences the outcomes for proximal third gastric adenocarcinoma. Materials and methods Review of prospective database at Tata Memorial Hospital from January 2010 to December 2012 identified 343 patients diagnosed and treated for gastric cancer. Of these, 75 underwent curative resections with D2 lymphadenectomy for proximal third gastric adenocarcinoma, which entailed proximal gastrectomy in 43 and total gastrec- tomy in 32 patients, depending on the epicenter of the primary and its relation with the mid-body of the stomach. Morbidity, lymph node yield, resection margins, patterns of recurrence, and survival were compared between these two groups. Results 41/75 tumors were pT3 (23 cases [53.4 %] in the PG and 18 cases [56.3 %] in the TG group). Thirty-six patients [83.7 %] in PG and 29 patients [90.6 %] in TG group received neoadjuvant chemotherapy (NACT). There were no signifi- cant differences with regard to median blood loss, general complication rates and length of hospitalization between the two groups. The lymph node yield was comparable between the two procedures [PG = 14; TG = 15]. Positive proximal resection margin rates were comparable between the two groups [PG = 4.7 %; TG= 9.4 %], and there was no statistical difference observed in the distal resection margin positivity rates [PG = 4.7 %; TG = 3.1 %]. Regarding the patterns of recurrence, local recurrence in PG was 4.7 % and there was no local recurrence in the TG group (p = 0.08). Distant recur- rence rates was dominant in TG [PG = 30.2 % versus TG=53.1 %]. The overall 2-year survival following PG and TG was 73.8 and 49.9 %, respectively, and not statistically different (p = 0.10). Conclusions The extent of resection for proximal third gastric cancer does not influence the clinical outcome. PG and TG have similar survival rates. Both procedures can be accom- plished safely. Therefore, PG should be an alternative to TG, even in locally advanced proximal gastric cancers treated by NACT, provided that the tumor size and location permit pres- ervation of adequate remnant of stomach without compromis- ing oncological resection margins. Future QOL studies would further lend credence to the concept of PG for proximal third gastric cancer. Keywords Proximal third gastric cancer . Siewert type II and III . Proximal gastrectomy . Total gastrectomy . D2 lymphadenectomy . Neoadjuvant chemotherapy . Gastro-esophageal junction cancer Introduction Gastric cancer remains a cancer with a high mortality rate the world over [1]. Over the past decades, the predominant site of occurrence has shifted from the distal to the proximal stomach [2, 3]. In North American and some European countries, ade- nocarcinoma of the cardia is the primary type of gastric cancer. Electronic supplementary material The online version of this article (doi:10.1007/s00423-016-1422-3) contains supplementary material, which is available to authorized users. * Shailesh V. Shrikhande shailushrikhande@hotmail.com 1 Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai 400 012, India Langenbecks Arch Surg DOI 10.1007/s00423-016-1422-3