title: Advanced gastric cancer in the middle one-third of the stomach: Should surgeons perform total gastrectomy?
abstract: OBJECTIVE
  To determine which optimal surgical procedure for middle-third advanced gastric cancer (AGC) based on comparative study of the long-term prognosis between total gastrectomy (TG) and distal gastrectomy (DG).
  
  
  METHODS
  Between March 1993 and December 2005, 402 patients with middle-third AGC who underwent gastric resection were enrolled in this study. We analyzed the long-term prognosis according to the length of the proximal resection margin (PRM) and the extent of gastric resection, and determined independent prognostic factors.
  
  
  RESULTS
  TG was performed in 244 patients (60.7%) and DG was performed in 158 patients (39.3%). There were no significant differences in the 5-year survival rates according to the length of PRM. The 5-year survival rates of patients who underwent DG were significantly higher than the rates of the patients who underwent TG in curative cases (67.8% vs. 58.4%, P = 0.037). Nevertheless, there was no significant difference in the stage-stratified survival rates according to the extent of gastric resection. Multivariate analysis revealed that surgical curability, extent of lymphadenectomy, and stage were independent prognostic factors.
  
  
  CONCLUSIONS
  If curative resection can be performed, the long-term prognosis of patients with middle-third AGC was not affected by the length of PRM or the extent of gastric resection.
authors.affiliation: Department of Surgery, Korea University College of Medicine, Seongbuk-gu, Seoul, Korea.
authors.forename: You-Jin
authors.initials: YJ
authors.lastname: Jang
authors.forename: Man-Sik
authors.initials: MS
authors.lastname: Park
authors.forename: Jong-Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Park
authors.forename: Seung-Heum
authors.initials: SH
authors.lastname: Park
authors.forename: Seung-Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Chong-Suk
authors.initials: CS
authors.lastname: Kim
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Mok
mesh_terms: D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate