Long-term results of proximal and total gastrectomy for adenocarcinoma of the upper third of the stomach.
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.
Yoo
Chang Hak
CH
Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea. chyoo63@naver.com
Sohn
Byung Ho
BH
Han
Won Kon
WK
Pae
Won Kil
WK
Surgery. 1998 Feb;123(2):127-30
9481396
Eur J Surg Oncol. 1990 Aug;16(4):404-9
2379597
Am J Surg. 1986 Sep;152(3):314-9
3752383
Br J Surg. 2003 Jul;90(7):850-3
12854112
Cancer. 1992 Aug 1;70(3):569-74
1623472
Am J Surg. 1988 Mar;155(3):481-5
3344914
Surg Today. 1997;27(11):993-8
9413049
Br J Surg. 1998 Nov;85(11):1457-9
9823902
Gastric Cancer. 1998 Dec;1(1):78-79
11957047
Cancer Res Treat. 2002 Aug;34(4):247-51
26680870
Eur J Surg. 1993 Sep;159(9):491-3
8274558
World J Surg. 1981 Mar;5(2):249-57
7245794
Br J Surg. 2000 May;87(5):618-26
10792320
Eur J Surg Oncol. 2003 Aug;29(6):506-10
12875856
J Surg Oncol. 1987 Oct;36(2):110-2
3657174
Am J Gastroenterol. 1997 Aug;92(8):1347-50
9260804
Am J Surg. 1995 Mar;169(3):316-9
7879834
Br J Surg. 2000 Feb;87(2):236-42
10671934
J Am Coll Surg. 1999 Dec;189(6):594-601
10589596
World J Surg. 1988 Apr;12(2):229-35
3394347
Int Surg. 1999 Jan-Mar;84(1):13-7
10421011
J Surg Oncol. 1995 Oct;60(2):83-8
7564386