A Retrospective Clinicopathological Study on Adenocarcinoma of the Upper Part of the Stomach with Special Reference to Lymph Node Metastases

Toshio Miura, Tatsuo Hirano*, Hiroyuki Kusano*, Tohru Nakagoe*, Teruhisa Shimizu*, Hiroshi Ishikawa*, Kosei Miyashita*, Akio Kawaguchi*, Takatoshi Shimoyama*, Hiroyoshi Ayabe*, Masao Tomita*

Department of Occupational Therapy, the School of Allied Medical Sciences, Nagasaki University
*First Department of Surgery, School of Medicine, Nagasaki University

Two hundred ninety-four patients with adenocarcinoma of the upper part of the stomach who underwent gastric resection were studied. We analyzed data on patients with lesions confined to the upper third of the stomach (43.9%) and on patients with lesions which, while primarily located in the upper portion of the stomach, had spread to the body of the stomach or esophagus. In this series, 72.8% of the patients were men with a median age of 60.0 years. Seventy-three percent of the patients had total gastrectomy, 17.8% had a proximal gastrectomy, 8.2% had a Billroth I or II gastrectomy, and 1.3% had a segmental or partial resection. Curative resection was carried out in 72.1%. Lymph node invasion was significantly highly correlated with the degree of tumor penetration of the gastric wall. None of the patients with lesions confined to the upper third of the stomach without macroscopically demonstrable serosal invasion had lymph node metastases in the suprapyloric, infrapyloric or along the left gastroepiploic. However, in patients with suspected serosal invasion, metastasis was found in 11.1%, 5.6%, and 2.8%, respectively. Total gastrectomy yielded a 5-year survival rate of 43.1%, proximal gastrectomy 32.5%, subtotal gastrectomy 83.3% and distal gastrectomy 44.4%. The 5-year survival rates after curative surgery were for total gastrectomy 58.1% and for proximal gastrectomy 42.7% with no significance difference. We conclude that proximal gastrectomy is indicated for patients with upper gastric carcinoma when it is confined to the upper third of the stomach and serosal invasion is not seen.

Key words
adenocarcinoma of the upper part of stomach, total gastrectomy, proximal gastrectomy, lymphnode metastasis

Reprint requests
Toshio Miura First Department of Surgery, Nagasaki University School of Medicine
7-1 Sakamoto-machi, Nagasaki, 852 JAPAN

Accepted
May 13, 1992

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