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Surgical outcomes for gastric cancer in the upper third of the stomach

Authors
Kim, Jong HanPark, Sung SooKim, JinBoo, Yoon JungKim, Seung JooMok, Young JaeKim, Chong Suk
Issue Date
Oct-2006
Publisher
SPRINGER
Citation
WORLD JOURNAL OF SURGERY, v.30, no.10, pp.1870 - 1878
Indexed
SCIE
SCOPUS
Journal Title
WORLD JOURNAL OF SURGERY
Volume
30
Number
10
Start Page
1870
End Page
1878
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/18598
DOI
10.1007/s00268-005-0703-8
ISSN
0364-2313
Abstract
Introduction: The proportion of gastric cancers affecting the upper third of the stomach has been increasing. At our surgical service we perform total and proximal gastrectomy for this condition. The purpose of this study was to investigate the surgical outcome of the two operative procedures and determine an optimal surgical approach. Methods: Data from 147 patients who underwent resection for gastric cancer affecting the proximal one-third of the stomach were retrospectively analyzed. The patients were classified into a total gastrectomy (TG) group or a proximal gastrectomy (PG) group, and the clinicopathologic characteristics and surgical results were compared. We analyzed survival rates using Kaplan-Meier methods and made comparisons using a log-rank test across the same stage of the gastric cancer. Results: From 1992 to 2000, a total of 104 total gastrectomies and 43 proximal gastrectomies for gastric cancer affecting the upper one-third of the stomach were performed. Our investigation revealed significantly different clinicopathologic characteristics in Borrmann type, length of the resection margin, degree of lymph node dissection, and lymph node stage. During the procedure, a combined resection of other organs was performed in 30 TG and 27 PG patients. Postoperative complications developed in 15 TG and 22 PG patients. The cancer recurrence rate was 4.8% for the TG group and 39.5% for the PG group; it was highest when the length of the proximal resection margin was < 1 cm. When we compared 5-year survival rates between the two groups, each at the same cancer stage, a significant difference was noted for stage III and IV gastric cancers. Conclusions: Proximal gastrectomy may be performed during the early stage of proximal gastric cancer; but because of the high frequency of complications and cancer recurrence, an additional procedure should be expected afterward. When the cancer stage is advanced, total gastrectomy should be performed with sufficient length of the proximal resection margin.
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2. Clinical Science > Department of Pediatric Surgery > 1. Journal Articles
2. Clinical Science > Department of Colon and Rectal Surgery > 1. Journal Articles
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Anam Hospital (Department of Colon and Rectal Surgery, Anam Hospital)
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