| Backgrounds and objections:Gastric cancer is one of the major malignant tumors that harmful to human health and cause death, studies have shown that the incidence of proximal gastric cancer is increasing year by year, with the increasing in cases of early gastric cancer, endoscopic mucosal resection (EMR) has become effective treatment for lesions confined within the mucosal But in China, surgery is still the main treatment. However, a lot of controversies remaining in the choice of surgical resection for proximal gastric cancer, until now, there is not an unified opinion regarding to make a total gastrectomy or proximal subtotal gastrectomy.At present, radical oesophagectomy and distal subtotal with preservation of the vagus nerve was considered as function-preserving operation,that can significantly improve the postoperative quality of life. However, little attention was put into the proximal gastric cancer with preservation of vagus nerve to evaluate the feasibility and its significance.The majority cases of proximal gastric cancer in China were found in advanced stage, how can we make the balance in the pursuit of radical cancer treatment and reducing the postoperative complication and improve the postoperative quality of life, has become the key issues in morden surgery. We carried out prospective clinical trial and systematic review of literature to evaluate the feasibility of preserving the vagus nerve during radical proximal gastrectomy, the safety of the novel procedure was evaluate by comparing the radical extent and lymph node dissection. The significance of the novel procedure was evaluate by status of postoperative quality of life (QOL) at the time point of six month after operation..Material and method:Proximal gastric cancer diagnosised in the general surgery center of jilin university between Jun 2007 to Jun 2009,confirmed by preoperative endoscopy and pathology examination, and without contraindication, a total of 39 cases were recruited ,with 28 cases of male and 11 cases of female.Aged from 50 to 69, with an average of 61. cases were randomized in proxiamal gastrectomy (PG) group and total gastrectomy (TG) group by using"randomized envelope"method;within the PG group, case were redistribuit into vagus nerve-preserving group (Vp-TG) and conventional group (V-TG) according to recruiting time. comparison among the clinical-pathological characteristics and postoperative quality of life conditions was carried out. Statistical analysis: Carried out by using the Statistical analysis soft SPSS15.0, the qualitative data present as the number of case, and the quantitative data present as mean±standard deviation. The count data used analysis of variance and chi-square-test, and measurement data by t-test, P<0.05 defined as a statistically significant difference. Results:(1) The extent of radical surgery and lymph node dissection scope: The percentage of D2 dissection were: 88.9%, 92.3% and 82.3% respectively, the average number of harvest lymph node among A, B, C groups was 28.0±2.83,28.46±3.75 and 29.05±5.1 respectively,with the P value >0.05,there is no statistically significant differences.(2) Spitzer score: The average scores among A, B, C three groups were: 8.1±1.1,7.0±1.1,16.9±2.9 respectively,with anf There is no statistically significant differences with the P value >0.05.(3) The incidence of diarrhea: The constituent ratio of A, B, C were 77.8%, 63.6% and 40.0% respectively, statistically significant difference was found as compared A with B and C with the P value >0.05.(4) The function of gallbladder: The contraction ratio of A, B, C were 88.9%, 63.6% and 33.3% respectively, statistically significant difference was found as compared C with A and B with the P value < 0.05.(5) The grade of esophagitis: The constituent ratio of (0+ I) among A and B were 44.4%, 27.3% respectively, statistically significant difference was found as compared these two group with the P value < 0.05.Conclusions:(1).It is feasible to conduct radical proximal subtotal gastrectomy with preservation of the vagus nerve, traditional criteria for radical resection of proximal gastric cancer can be achieved and should be adopt as regarding the radical range of tumor resection and lymph node dissection.(2).proximal subtotal gastrectomy with preservation of the vagus nerve, may improve postoperative reflux esophagitis, future studies were need to explore the impact on reflux symptoms.(3).Large volume RCT were need to study the impact of proximal subtotal gastrectomy with preserving of the vagus on the postoperative overall quality of life, and the bile duct,pancreas and intestinal function...
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