THE OPERATIVE INDICATIONS FOR PROXIMAL GASTRECTOMY IN PATIENTS WITH GASTRIC-CANCER IN THE UPPER 1 3 OF THE STOMACH/

While proximal gastrectomy is often performed for early gastric cancer in Japan, it remains unclear whether or not proximal gastrectomy shou ld be performed for advanced gastric cancer, This study was designed t o determine the operative indications for proximal gastrectomy in pati ents with gastric cancer in the upper third of the stomach, A total of 1691 patients with gastric cancer were reviewed retrospectively from hospital records during the period from 1969 to 1994, and the clinicop athologic characteristics of 82 patients who underwent proximal gastre ctomy were compared with those of 150 patients who underwent total gas trectomy. Lymph node metastasis along the lower part of the stomach wa s observed in gastric cancers which had invaded beyond the muscularis propria of the stomach, but not in those confined to the muscularis pr opria, Three patients with gastric cancer that had invaded beyond the muscularis propria and metastasized to nodes along the lower part of t he stomach were cured by total gastrectomy. However, there was no diff erence in the postoperative survival rates of the patients treated wit h proxi mal gastrectomy and those treated,vith total gastrectomy, irre spective of tumor stage and depth of invasion, Thus, proximal gastrect omy should be performed for gastric cancer when the depth of invasion is confined to the muscularis propria of the stomach.