The Indication of Proximal Gastrectomy for Gastric Cancer

Masayoshi Hioki, Naoto Gotohda, Taira Kinoshita, Masaru Konishi, Toshio Nakagohri and Shinichiro Takahashi

Department of Digestive Surgery, National Cancer Center Hospital East

Introduction: We retrospectively reviewed cases of proximal gastrectomy without splenectomy conducted in patients with upper gastric cancer to determine the optimal indication of proximal gastrectomy for gastric cancer. Patients and Methods: Between July 1992 and September 2007, 206 patients underwent proximal gastrectomy. We reviewed patient and tumor features, prognosis, and recurrence. Results: Histological depth of 206 patients was pM in 49, pSM in 121, pMP in 28, pSS in 7, and pSE in 1. Lymph node metastasis was pN1 in 22, pN2 in 3. Cumulative 5-year survival rate was 92.5% for pStage IA, 86.0% for pStage IB, and 61.5% for pStage II. Postoperative recurrence occurred in 5 patients, mediastinal lymph node metastasis in 3, lung metastasis in 1, splenic hilum lymph node metastasis in 2. Depths of invasion in all recurrent cases were equal to or deeper than MP. Discussion: Our results suggest that the "optimal" indication for proximal gastrectomy without splenectomy should be restricted for early gastric cancer.

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

Reprint requests
Masayoshi Hioki Department of Digestive Surgery, National Cancer Center Hospital East
6-5-1 Kashiwanoha, Kashiwa, 277-8577 JAPAN

Accepted
December 17, 2008

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