PROXIMAL SUBTOTAL GASTRECTOMY FOR THE TREATMENT OF CARCINOMA OF THE UPPER 3RD OF THE STOMACH - ITS INDICATIONS BASED ON LYMPH-NODE METASTASIS AND PERIGASTRIC LYMPHATIC FLOW

To clarify the indications for a proximal subtotal gastrectomy in the treatment of carcinoma in the upper third of the stomach based on lymp h node metastases, 1055 patients in whom either a D-2 or greater lymph node removal was performed were reviewed. In the patients in which th e lesion was confined to the upper stomach and did not invade beyond t he muscularis propria of the stomach wall, no metastases to either the lymph nodes above and below the pylorus or the lymph nodes along the greater curvature were observed. A lymphatic flow study revealed a min imal flow to these nodes from the upper stomach in patients without ly mph node metastasis, but in cases with lymph node metastases the lymph atic flow changed. The indications for a proximal subtotal gastrectomy for a carcinoma of upper third of the stomach therefore must fulfill the following two conditions: (1) The deepest layer of cancerous invas ion does not extend beyond the muscularis propria of the stomach wall, and (2) No macroscopic evidence of lymph node metastasis can be detec ted during surgery.