title: [Selection of radical operative modalities for proximal gastric cancer].
abstract: OBJECTIVE
  To evaluate the rationality of different radical operative modalities for proximal gastric cancer.
  
  
  METHODS
  A total of 366 cases of proximal gastric cancer undergoing radical dissection were screened from data base. According to the operative modalities, they were divided into proximal gastrectomy group (PG) (n = 77) and total gastrectomy group (TG) (n = 289). Through the comparisons of clinical pathologic features, surgical profiles, postoperative complications, postoperative quality-of-life and prognosis in two groups, the rationality of different operative modalities was evaluated.
  
  
  RESULTS
  No significant differences existed in age, gender or carcinoembryonic antigen (CEA) value between two groups (all P > 0.05). The rates of tumor diameter ≥ 5 cm, organic infiltration, lymph nodes metastasis, distal organs metastasis, infiltrative type, poorly differentiated tumor in PG and TG groups were 15.6% (12/77) vs 49.8% (144/289), 16.9% (13/77) vs 37.7% (109/289), 67.5% (52/77) vs 79.9% (231/289), 3.9% (3/77) vs 11.4% (33/289), 45.5% (35/77) vs 68.9% (199/289), 32.5% (25/77) vs 57.8% (167/289) respectively (all P < 0.05). Operative duration, volume of blood transfusion, number of dissected lymph nodes and positive lymph nodes, rate of combined organic resection and complications in groups of PG and TG were (256 ± 83) vs (298 ± 86)min, 0 vs 400 ml, 15 ± 12 vs 26 ± 15, 0 vs 3, 15.6% (12/77) vs 43.2% (125/289), 14.3% (11/77) vs 7.6% (22/289) respectively (all P < 0.05). In two groups, the evaluating indices of postoperative quality-of-life showed no significant differences (P > 0.05). In two groups, the median survival time of the cases with tumor diameter < 5 cm, no-organic infiltration, no-peri-tumor lymph nodes metastasis, no-distal organic metastasis had no significant difference (all P > 0.05). However, in groups of PG and TG, the median survival time of the cases with tumor diameter ≥ 5 cm, organic infiltration, peri-tumor lymph nodes metastasis and distal organic metastasis was 15.0 months vs 29.0 months, 15.0 months vs 30.0 months, 34.0 months vs 45.0 months, 4.0 months vs 18.0 months respectively(all P < 0.05).
  
  
  CONCLUSIONS
  As compared with radical proximal gastrectomy, radical total gastrectomy improves significantly the prognosis of patients of proximal gastric cancer with organic infiltration, peri-tumor lymph nodes metastasis, distal organic metastasis and tumor diameter ≥ 5 cm.
authors.affiliation: Gastrointestinal Department, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wu
authors.forename: Yu-long
authors.initials: YL
authors.lastname: He
authors.forename: Jian-bo
authors.initials: JB
authors.lastname: Xu
authors.forename: Shi-rong
authors.initials: SR
authors.lastname: Cai
authors.forename: Jin-ping
authors.initials: JP
authors.lastname: Ma
authors.forename: Chuang-qi
authors.initials: CQ
authors.lastname: Chen
authors.forename: Xin-hua
authors.initials: XH
authors.lastname: Zhang
authors.forename: Liang
authors.initials: L
authors.lastname: Wang
authors.forename: Wen-hua
authors.initials: WH
authors.lastname: Zhan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery*