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Advanced gastric cancer in the middle one-third of the stomach: Should surgeons perform total gastrectomy?
You-Jin Jang1, Man-Sik Park, Jong-Han Kim
1Department of Surgery, Korea University College of Medicine, Seongbuk-gu, Seoul, Korea.
Background And Objectives:
To determine which optimal surgical procedure for middle-third advanced gastric cancer (AGC) based on comparative study of the long-term prognosis between total gastrectomy (TG) and distal gastrectomy (DG).
Methods:
Between March 1993 and December 2005, 402 patients with middle-third AGC who underwent gastric resection were enrolled in this study. We analyzed the long-term prognosis according to the length of the proximal resection margin (PRM) and the extent of gastric resection, and determined independent prognostic factors.
Results:
TG was performed in 244 patients (60.7%) and DG was performed in 158 patients (39.3%). There were no significant differences in the 5-year survival rates according to the length of PRM. The 5-year survival rates of patients who underwent DG were significantly higher than the rates of the patients who underwent TG in curative cases (67.8% vs. 58.4%, P = 0.037). Nevertheless, there was no significant difference in the stage-stratified survival rates according to the extent of gastric resection. Multivariate analysis revealed that surgical curability, extent of lymphadenectomy, and stage were independent prognostic factors.
Conclusion:
If curative resection can be performed, the long-term prognosis of patients with middle-third AGC was not affected by the length of PRM or the extent of gastric resection.
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