{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T23:18:29Z","timestamp":1782947909806,"version":"3.54.5"},"reference-count":44,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The optimal surgical approach for locally advanced proximal gastric cancer (LAPGC) remains controversial. While total gastrectomy (TG) is widely accepted, proximal gastrectomy (PG) is increasingly considered to preserve function. This study represents the first meta-analysis to comprehensively compare the surgical and oncological outcomes of PG versus TG for LAPGC using data from propensity score-matched (PSM) studies, addressing a critical gap in surgical decision-making.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive search of various electronic databases was conducted. Studies comparing PG and TG in LAPGC with PSM methodology were included. Pooled hazard ratios (HRs), odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CI) were calculated using a random-effects\u00a0model. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Secondary outcomes included surgical metrics and postoperative complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 265 articles were screened, and five retrospective studies were included in this meta-analysis, comprising 412 patients after PSM. Surgical approaches (OR 1.03, P = 0.896), positive surgical margins (OR 2.83, P = 0.08), and adjuvant chemotherapy rates (OR 1.07, P = 0.19) were similar between the PG and TG groups. PG resulted in significantly shorter operative times (MD 25.7, P&amp;lt;0.001) but higher blood loss (MD -21.65, P = 0.02) and fewer lymph nodes harvested (MD 6.23, P&amp;lt;0.001). Furthermore, the number of metastatic lymph nodes was similar between the two groups (MD 0.62, P = 0.07), with the exception of lymph node stations 5 and 6, where the metastatic rates in the TG group were 0.82% and 1.6% (P = 0.645), respectively. Postoperative complications were lower in the PG group, but the difference was not statistically significant (OR 1.24, P = 0.289). Hospital stay was significantly shorter in the PG group (MD 0.81, P = 0.001). No significant differences in the 5-year OS or RFS were found (HR 0.99, P = 0.48 for OS; HR 0.83, P = 0.87 for RFS). Sensitivity and publication bias analyses supported the robustness and consistency of the results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>For selected patients with LAPGC, PG offers similar curative potential and oncological efficacy as TG, making it a safe option.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1632011","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:13:08Z","timestamp":1758859988000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Proximal vs. total gastrectomy for proximal advanced gastric cancer: a systematic review and meta-analysis of propensity score-matched studies"],"prefix":"10.3389","volume":"15","author":[{"given":"Chengcong","family":"Liu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-024-15048-8","article-title":"Long-term outcome of proximal gastrectomy for upper-third advanced gastric and siewert type II esophagogastric junction cancer compared with total gastrectomy: A propensity score-matched analysis","volume":"31","author":"Lee","year":"2024","journal-title":"Ann Surg Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s10120-020-01129-6","article-title":"Multicenter prospective trial of total gastrectomy versus proximal gastrectomy for upper third cT1 gastric cancer","volume":"24","author":"Yamasaki","year":"2021","journal-title":"Gastric Cancer"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2022.11.018","article-title":"Systematic review and meta-analysis comparing proximal gastrectomy with double-tract-reconstruction and total gastrectomy in gastric and gastroesophageal junction cancer patients: Still no sufficient evidence for clinical decision-making","volume":"173","author":"Hipp","year":"2023","journal-title":"Surgery"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2024.1023","article-title":"Laparoscopic spleen-preserving hilar lymphadenectomy for advanced proximal gastric cancer without greater curvature invasion: five-year outcomes from the fuges-02 randomized clinical trial","volume":"159","author":"Lin","year":"2024","journal-title":"JAMA Surg"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/js9.0000000000001325","article-title":"Long-term survival outcomes of robotic total gastrectomy for locally advanced proximal gastric cancer: a prospective study","volume":"110","author":"Zhong","year":"2024","journal-title":"Int J Surg"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2024.02.026","article-title":"A clinicopathologic feature-based nomogram for preoperative estimation of splenic hilar lymph node metastasis in advanced proximal gastric cancer without invasion of the greater curvature","volume":"176","author":"Cai","year":"2024","journal-title":"Surgery"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-022-11939-w","article-title":"Is prophylactic splenectomy necessary for proximal advanced gastric cancer invading the greater curvature with clinically negative splenic hilar lymph node metastasis? 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