To compare the clinical efficacy of proximal gastrectomy with total gastrectomy for cardia carcinoma.

The clinical data of one hundred and eighty-five patients with cardia carcinoma from January 2009 to January 2013 were reviewed, and 79 cases underwent proximal gastrectomy (proximal group), 106 cases underwent total gastrectomy (total gastrectomy group). The operation, long-term survival and complications were compared between the two groups.

All of the patients underwent the operation successfully. The operation time and blood loss in the total group were higher than those in the proximal group (t=5.015, 3.852, both P<0.01), but the hospital stay and incidence of perioperative complications were comparable in the two groups. The follow-up duration ranged from 6.2 to 71.5 months, and the follow-up rate was 88.6%. The 1-, 3-, and 5-year overall survival rate in the proximal group was 75.3%, 28.4% and 19.3% respectively, and 80.0%, 46.8% and 32.7% respectively in the total group. There was significant difference in the overall survival between the two groups (P=0.010). But the differences in the overall survival of stage, Ⅱ and Ⅲ between the two groups were not statistically significant. The incidence of anastomotic stenosis and 1-year score of gastroesophageal reflux disease questionnaire (GERD-Q) in the proximal group were higher than those in the total group (both P<0.05), but the differences of marginal ulcer, adhesive ileus and score of nutrition risk screening 2002 (NRS-2002) between the two groups were not significant.

Compared with proximal gastrectomy, total gatrectomy can improve the overall survival, reduce the incidence rate of anastomotic stenosis and reflux symptoms for cardia carcinoma.