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Updated: Mar 9, 2026
Intraoperative Gastroscopy for Tumor Localization in Laparoscopic Surgery for Gastric Adenocarcinoma
Published on: August 9, 2016
DO PROXIMAL AND DISTAL GASTRIC TUMOURS BEHAVE DIFFERENTLY?
Laurence Bedin da Costa1, Marcelo Garcia Toneto2, Luis Fernando Moreira3
1Postgraduate Program in Medicine, Surgical Sciences, Universidade Federal do Rio Grande do Sul; RS, Brazil.
Background:
Although the incidence of gastric (adenocarcinoma) cancer has been decreasing over time, it is still one of the most common malignancies worldwide, and proximal tumours tend to have a worse prognosis.
Aim:
To compare surgical outcomes and prognosis between proximal - excluding tumours of the cardia - and distal gastric cancer.
Methods:
Out of 293 cases reviewed - 209 with distal and 69 with proximal gastric cancer - were compared for clinical and pathological features, stage, surgical outcome, mortality and survival.
Results:
Statistically, there was no significant difference between patients in both groups regarding mortality (p=0.661), adjuvant chemotherapy (p 0.661), and radiation (p=1.000). However, there was significant difference in the degree of lymph node dissection employed (p=0.002) and the number of positive lymph nodes resected (p=0.038) between the two groups. The odds of death at five years for patients who had a D0 dissection was three times greater (odds ratio 2.78; (95%CI 1.33-5.82) than that for patients who had a D2 dissection, while for patients who had a D1 dissection the odds ratio was only 1.41 (95%CI 0.71-2.83) compared to D2-dissected patients.
Conclusion:
Although no significant differences were found between proximal and distal gastric cancer, the increased risk of death in D0- and D1-dissected patients clearly suggests an important role of radical D2 lymph node dissection in survival.
