The Indications of Proximal Gastrectomy for Gastric Cancer in the Upper Third of the Stomach

Tsutomu Kaetsu, Masatoshi Kawamura, Hiroyuki Nagayama, Koichi Takamura, Nobuo Komatsu, Kenji Marumori, Hideaki Kobayashi, Satoshi Suzuki, Kazushige Arai, Mitsuo Kusano

Second Department of Surgery, Showa University School of Medicine

We investigated the indications for proximal gastrectomy for gastric cancer in the upper third of the stomach. Three hundred eighteen resected stomachs (C, CM, CE) were evaluated. The percentage of lymph node metastasis at each depth of tumor invasion was as follows: m 0% (0/23), sm 6.1% (2/33), mp 25% (4/16), ss 74.1% (43/58), se 81.3% (104/128), and si 91.7% (55/60). In the patients with early gastric cancer, lymph node metastases were found in station numbers 1 and 7. Lymph node metastases in the patients with mp invasion were found in stations 1, 2, 3 and 11, but not in numbers 4d, 5, 6 and 10. As regards the recurrence, there was no lymph node recurrence of proximal gastric cancer which did not extend beyond mp after curative resection. In respect of prognosis, the 5-year survival rates for the patients with proximal and total gastrectomy were 86.7% and 74%, respectively. There was no difference in the cumulative survival rates between the two groups. In conclusion, D1+No 7 dissection should be performed for early gastric cancer. D1+No 7, 11 dissection is necessary for patients with mp cancer. Thus it is possible to perform proximal gastrectomy for proximal gastric cancer that was not beyond the layer of mp. However, the percentasge of metastasis to lymph node groups 2, 3 and 4 has increased according to the depth of invasion. Therefore, extended surgery should be performed for gastric cancer that is deeper than mp.

Key words
proximal gastrectomy, gastric cancer in the upper third of the stomach

Reprint requests
Tsutomu Kaetsu Second Department of Surgery, Showa University School of Medicine
1-5-8 Hatanodai Shinagawa-ku, Tokyo, 142 JAPAN

Accepted
June 11, 1997

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