[Extension and reduction of surgery of cancer occupying mainly the upper third part of the stomach--indications and limitations].
To improve the therapeutic result of patients with advanced carcinoma of the upper third of the stomach, it is necessary to extend further the range of resection and dissection especially in case of invading the lower esophagus with serosal involvement. The extended surgery consists of the following: abdominophrenicotomy or abdominothoractomy, lower esophagectomy and total gastrectomy, dissecting completely the second group of nodes combined with distal pancreatectomy and splenectomy, a block resection of adjacent organs in case of direct invasion, and even dissection of nodes in the lower mediastinum, within the hepatoduodenal ligament, behind the head of the pancreas and along the superior mesenteric vein. Operative procedures are, however, to be palliative in case of moderate or severe peritoneal or hepatic involvements or distant metastasis to the fourth group of nodes. Reduced procedures in case of no serosal invasion nor lymph node metastasis consist of 1/2 proximal gastrectomy and of dissection of the first group of nodes especially in superficial carcinoma. However, in cases free from serosal invasion but with metastasis to the first group of nodes or in cases with a slight serosal invasion, total gastrectomy with dissection up to the second group of nodes is recommended.
Hirose
S
S
Okayama Saiseikai General Hospital.
Mano
K
K
Kataoka
K
K
Kitamura
M
M
Tsutsui
N
N
Ohara
T
T
Kimura
H
H
D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008207:Lymphatic Metastasis / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*