EXTENDED TOTAL GASTRECTOMY FOR CARCINOMA OF THE CARDIA

Eighty-five patients with gastric carcinoma developing at or involving the cardia were operated on under a newly established principle to pr event a cancer-positive proximal margin. The choice of operative proce dure, standard total gastrectomy or extended total gastrectomy, was de termined by the degree of proximal extension of carcinoma as confirmed by preoperative examinations. The cancer-positive rate was decreased in this manner to 1.2 % from the 13.8 % of the controls operated on be fore the principle was established. Extended total gastrectomy without sternotomy should be used more frequently than that with sternotomy b ecause of the technical advantages. Survival rates of the 85 patients were 48.3 % at three years and 30.4 % at five years after the operatio n, and were not significantly different from the controls. As post-ope rative survival rate is influenced by factors other than transmural ex tension of the tumor, this study should prompt us to focus on the prob lem of the proximal surgical margin in surgery for carcinoma of the ga stric cardia.