[Rational surgical operations for advanced cancers located in the middle of the stomach]

Before 1982, total gastrectomy with pancreaticosplenectomy was performed for advanced gastric carcinoma which exposed to the serosa and was located in the middle of the stomach (M). The results of that surgical treatment were evaluated, and new surgical approaches were expected to provide a much better prognosis to patients. (1) A radical surgical operation, left upper abdominal evisceration + Appleby's method (LUAE + Apl), was tried for Borrmann type 4 gastric cancers from 1983. The 3-year survival after LUAE + Apl (77.9%) was better than that after total gastrectomy with pancreaticosplenectomy (35.0%) (p less than 0.05). In terms of the postoperative condition, no significant differences were observed between both operations. (2) As a conservative operation, total gastrectomy with resection of the spleen and splenic artery (Group A) was compared with total gastrectomy plus pancreaticosplenectomy (Group B) in patients with advanced gastric carcinoma other than Borrmann type 4. The 5-year survival was similar in both groups. The incidence of postoperative disorders was lower in Group A than in Group B (p less than 0.05). LUAE + Apl for Borrmann type 4 and total gastrectomy with resection of the spleen and splenic artery for the other advanced gastric cancers led to good results. These rational surgical operations will be necessary to achieve a good quality of life for the patients.