title: Pattern of surgical treatment for early gastric cancers in upper third of the stomach.
abstract: OBJECTIVE
  Various surgical treatments are indicated for early gastric cancers in upper third of the stomach (U-EGC) because of its anatomical property and favorable prognosis.
  
  
  METHODS
  Five hundred and eighty six cases of U-EGCs were collected for 9 years from 19 hospitals in Japan. Surgical procedures were classified as total (TG) and proximal gastrectomy (PG), and the latter was subclassified as esophagogastrostomy (PG-EG) and jejunal interposition (PG-JI) reconstruction.
  
  
  RESULTS
  TG was more frequent than PG (76.3% vs. 21.8%, p<0.0001). PG was more frequently performed in high volume hospitals than in low volume hospitals (26.8% vs. 10.2%, p<0.0001), however there were still large difference in frequency of PG even among high volume hospitals, ranging from 5.0% to 72.0%. For reconstruction after PG, PG-EG and PG-JI were representatively performed in 50 (39.1%) and 35 (27.3%) patients. Each institute tended to preferentially employ either PG-EG or PG-JI. Tumor size was significantly larger in TG than in PG (38.8mm vs. 22.3mm, p<0.0001) and diffuse type tended to be more frequent in TG as well.
  
  
  CONCLUSIONS
  There is a huge variety of surgical treatment for U-ECG in general hospitals in our country. A multi-institutional large cohort randomized trial might be urgent to establish the standard surgical procedure of this infrequent disease.
authors.affiliation: Osaka University Graduate School of Medicine, Department of Gastroenterological Surgery, Osaka, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Toru
authors.initials: T
authors.lastname: Masuzawa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kimura
authors.forename: Junya
authors.initials: J
authors.lastname: Fujita
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tamura
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y; D016009:Chi-Square Distribution; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007564:Japan; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*