title: Surgical outcomes for gastric cancer in the upper third of the stomach.
abstract: BACKGROUND
  The proportion of gastric cancers affecting the upper third of the stomach has been increasing. At our surgical service we perform total and proximal gastrectomy for this condition. The purpose of this study was to investigate the surgical outcome of the two operative procedures and determine an optimal surgical approach.
  
  
  METHODS
  Data from 147 patients who underwent resection for gastric cancer affecting the proximal one-third of the stomach were retrospectively analyzed. The patients were classified into a total gastrectomy (TG) group or a proximal gastrectomy (PG) group, and the clinicopathologic characteristics and surgical results were compared. We analyzed survival rates using Kaplan-Meier methods and made comparisons using a log-rank test across the same stage of the gastric cancer.
  
  
  RESULTS
  From 1992 to 2000, a total of 104 total gastrectomies and 43 proximal gastrectomies for gastric cancer affecting the upper one-third of the stomach were performed. Our investigation revealed significantly different clinicopathologic characteristics in Borrmann type, length of the resection margin, degree of lymph node dissection, and lymph node stage. During the procedure, a combined resection of other organs was performed in 30 TG and 27 PG patients. Postoperative complications developed in 15 TG and 22 PG patients. The cancer recurrence rate was 4.8% for the TG group and 39.5% for the PG group; it was highest when the length of the proximal resection margin was < 1 cm. When we compared 5-year survival rates between the two groups, each at the same cancer stage, a significant difference was noted for stage III and IV gastric cancers.
  
  
  CONCLUSIONS
  Proximal gastrectomy may be performed during the early stage of proximal gastric cancer; but because of the high frequency of complications and cancer recurrence, an additional procedure should be expected afterward. When the cancer stage is advanced, total gastrectomy should be performed with sufficient length of the proximal resection margin.
authors.affiliation: Department of Surgery, Korea University College of Medicine, 126-1, 5-ga, Anam-dong, Sung buk-gu, 136-705, Seoul, Korea.
authors.forename: Jong Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Park
authors.forename: Jin
authors.initials: J
authors.lastname: Kim
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Boo
authors.forename: Seung Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Mok
authors.forename: Chong Suk
authors.initials: CS
authors.lastname: Kim
mesh_terms: D002299:Cardia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome