title: Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach.
abstract: OBJECTIVE
  The choice of surgical strategy for patients with adenocarcinoma of the upper one third of the stomach is controversial. This study was performed to analyze the surgical results of a 11-year experience with these lesions.
  
  
  METHODS
  From January 1990 to December 2000, 259 patients with upper third gastric cancer underwent proximal gastrectomy (n=74) or total gastrectomy (n=185) through an abdominal approach. Morbidity, mortality, recurrence patterns, and survival were compared between these two groups retrospectively.
  
  
  RESULTS
  There were no significant differences in general complication and mortality rates between the two groups. However, the incidences of reflux esophagitis (16.2%) and anastomotic stricture (35.1%) were more common in the proximal gastrectomy group compared with the total gastrectomy group (0.5 and 8.1%). Regarding the main patterns of recurrence, local recurrence was dominant in the proximal gastrectomy group, whereas distant recurrence was dominant in the total gastrectomy group. Five-year overall survival (54.8 versus 47.8%) and survival according to tumor stage were no different between the groups. Multivariate analysis showed that the extent of resection was not an independent prognostic factor.
  
  
  CONCLUSIONS
  The extent of resection for upper third gastric cancer did not appear to affect long-term outcome. However, proximal gastrectomy is associated with an increased risk of reflux esophagitis, anastomotic stricture, and local recurrence.
authors.affiliation: Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea. chyoo63@naver.com
authors.forename: Chang Hak
authors.initials: CH
authors.lastname: Yoo
authors.forename: Byung Ho
authors.initials: BH
authors.lastname: Sohn
authors.forename: Won Kon
authors.initials: WK
authors.lastname: Han
authors.forename: Won Kil
authors.initials: WK
authors.lastname: Pae
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