Cancer Res Treat.  2004 Feb;36(1):50-55.

Long-term Results of Proximal and Total Gastrectomy for Adenocarcinoma of the Upper Third of the Stomach

• Yoo CH
• Sohn BH
• Han WK
• Pae WK

Abstract

PURPOSE
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. MATERIALS AND 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. CONCLUSION: 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.

Keyword

Stomach neoplasm; Surgical treatment; Recurrence; Prognosis

MeSH Terms

Adenocarcinoma*
Constriction, Pathologic
Esophagitis, Peptic
Gastrectomy*
Humans
Incidence
Mortality
Multivariate Analysis
Prognosis
Recurrence
Retrospective Studies
Stomach Neoplasms
Stomach*

Figure

• 

  Fig. 1 Cumulative survival of patients treated by proximal and total gastrectomy. p=0.378 (log-rank test).

• 

  Fig. 2 Cumulative survival of patients treated by proximal and total gastrectomy according to UICC TNM A: stage I (p=0.141), B: stage II (p=0.926), C: stage III (p=0.138), D: stage IV (p=0.253).

Reference

1. Borch K, Jnsson B, Tarpila E, Franzen T, Berglund J, Kullman E, Franzen L. Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma. Br J Surg. 2000; 87:618–626. PMID: 10792320.

2. de Calan L, Portier G, Ozoux JP, Rivallain B, Perrier M, Brizon J. Carinoma of the cardia and proximal third of the stomach. Am J Surg. 1988; 155:481–485. PMID: 3344914.

3. Kaibara N, Nishimura O, Nishidoi H. Proximal gastrectomy as the surgical procedure of choice for upper gastric carcinoma. J Surg Oncol. 1987; 36:110–112. PMID: 3657174.

4. Kitamura K, Yamaguchi T, Okamoto K, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. Total gastrectomy for early gastric cancer. J Surg Oncol. 1995; 60:83–88. PMID: 7564386.

5. Japanese Gastric Cancer Association. The new Japanese Classification of Gastric Carcinoma, 2nd English ed. Gastric Cancer. 1998; 1:1–15. PMID: 11957036.

6. Sobin LH, Wittekind CH. International Union Against Cancer. TNM Classification of Malignant Tumors. 1997. 5th ed. New York: Wiley-Liss.

7. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998; 85:1457–1459. PMID: 9823902.

8. Blomjous JGAM, Hop WCJ, Langenhorst BLAM, ten Kate FJW, Eykenboom WMH, Tilanus HW. Adenocarcinoma of the gastric cardia. Recurrence and survival after resection. Cancer. 1992; 70:569–574. PMID: 1623472.

9. de Manzoni G, Pedrazzani C, Pasini F, Durante E, Gabbani M, Grandinetti A, Guglielmi A, Griso C, Cordiano C. Pattern of recurrence after surgery in adenocarcinoma of the gastrooesophageal junction. Eur J Surg Oncol. 2003; 29:506–513. PMID: 12875856.

10. Kodera Y, Yamamura Y, Shimizu Y, Torii A, Hirai T, Yasui K, Morimoto T, Kato T. Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert's classification applied to 177 cases resected at a single institution. J Am Coll Surg. 1999; 189:594–601. PMID: 10589596.

11. Siewert JR, Stein HJ. Carcinoma of the cardia: carcinoma of the gastroesophageal junction-classification, pathology and extent of resection. Dis Esophagus. 1996; 9:173–182.

12. Shimada H, Suzuki T, Nakajima K, Hori S, Hayashi H, Takeda A, Arima M, Gunji Y, Koide Y, Ochiai T. Lymph node metastasis with adenocarcinoma of the gastric cardia: clinicopathological analysis and indication for D1 dissection. Int Surg. 1999; 84:13–17. PMID: 10421011.

13. Jakl RJ, Miholic J, Koller R, Markis E, Wolner E. Prognostic factors in adenocarcinoma of the cardia. Am J Surg. 1995; 169:316–319. PMID: 7879834.

14. Moreaux J, Msika S. Carcinoma of the gastric cardia: surgical management and long-term survival. World J Surg. 1988; 12:229–235. PMID: 3394347.

15. Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery. 1998; 123:127–130. PMID: 9481396.

16. Kitamura K, Yamaguchi T, Nishida S, Yamamoto K, Ichikawa D, Okamoto K, Taniguchi H, Hagiwara A, Sawai K, Takahashi T. The operative indications for proximal gastrectomy in patients with gastric cancer in the upper third of the stomach. Surg Today. 1997; 27:993–998. PMID: 9413049.

17. Inberg MV, Heinonen R, Lauren P, Rantakokko V, Viikari J. Total and proximal gastrectomy in the treatment of gastric cardia: a series of 305 cases. World J Surg. 1981; 5:249–257. PMID: 7245794.

18. Buhl K, Schlag P, Herfarth C. Quality of life and functional results following different types of resection for gastric carcinoma. Eur J Surg Oncol. 1990; 16:404–409. PMID: 2379597.

19. Hsu CP, Chen CY, Hsieh YH, Hsia JY, Shai SE, Kao CH. Esophagial reflux after total or proximal gastrectomy in patients with adenocarcinoma of the gastric cardia. Am J Gastroenterol. 1997; 92:1347–1350. PMID: 9260804.

20. Matsushiro T, Hariu T, Nagashima H, Yamamoto K, Imaoka Y, Yamagata R. Valvuloplasty plus fundoplasty to prevent esophageal regurgitation in esophagogastrostomy after proximal gastrectomy. Am J Surg. 1986; 152:314–319. PMID: 3752383.

21. Shiraishi N, Hirose R, Morimoto A, Kawano K, Adachi Y, Kitano S. Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy. Gastric Cancer. 1998; 1:78–79. PMID: 11957047.

22. Katai H, Sano T, Fukagawa H, Shinohara H, Sasako M. Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg. 2003; 90:850–853. PMID: 12854112.

23. Kameyama J, Ishida H, Yasaku Y, Suzuki A, Kuzu H, Tsukamoto M. Proximal gastrectomy reconstructed by interposition of a jejunal pouch. Eur J Surg. 1993; 159:491–493. PMID: 8274558.

24. Yoo CH, Noh SH, Shin DW, Choi SH, Min JS. Recurrence following curative resection for gastric carcinoma. Br J Surg. 2000; 87:236–242. PMID: 10671934.

25. Yoo CH, Sohn BH, Han WK, Pae WK. Analysis of local recurrence following proximal gastrectomy in patients with upper third gastric cancer. Cancer Res Treat. 2002; 34:28–31.