TOTAL GASTRECTOMY IS NOT NECESSARY FOR PROXIMAL GASTRIC-CANCER

Background. Although there is an increasing incidence of proximal gast ric cancers in the United States, the appropriate extent of resection for proximal gastric cancer is not known. This study addresses whether the type of operation (total gastrectomy [TC] vs proximal gastrectomy [PG]) affects outcome for proximal gastric adenocarcinoma. Methods. R eview of the prospective gastric database at Memorial Sloan-Kettering Cancer Center from July 1985 to August 1995 identified 391 patients wi th proximal gastric cancer Of those patients, 98 underwent curative TG or PG through an exclusively abdominal approach. Patients undergoing esophagogastrectomy (n = 283) were excluded fi-om analysis. Data are e xpressed as medians and ranges. Results. The length of hospital stay w as the same for patients undergoing resection for PG (16.5 days [range 8 to 55]) and for TG (18 days [range 8 to 48]). In addition, hospital mortality rates for PG (6.0%) were similar to those for TG (3.0%). Th ere was no significant difference in tumor differentiation and overall stage between the groups that underwent TG and those that underwent P G. There was no significant difference in time to recurrence between t he two operative groups (PG, 15.7 months, versus TG, 18 months). In ad dition, there was no association between first site of recurrence and type of procedure. The overall 5-year survival rate for proximal gastr ic cancer was 43% (median survival 46 months), whereas the 5-year surv ival rate for TG was 41 % (median survival 51 months,. difference not significant). Conclusions. The extent of resection for proximal gastri c cancer does not affect long-term outcome. TG and PG have similar ove rall survival rates and time and rate of recurrence, and both procedur es can be accomplished safely.