PROXIMAL GASTRIC CANCERS RESECTED VIA A TRANSABDOMINAL-ONLY APPROACH - RESULTS AND COMPARISONS TO DISTAL ADENOCARCINOMA OF THE STOMACH

Objective The purpose of this study is to compare the outcome of patie nts with proximal gastric cancer (PGC) treated by a transabdominal-onl y resection to that of patients with distal gastric cancer (DGC). Summ ary Background Data It has been suggested that PGC is inherently more aggressive than DGC. The worse survival oi PGC compared with that of D GC may be, in part, because of the difficulty distinguishing PGC from distal esophageal adenocarcinoma. By defining a subset of PGC resected using an transabdominal-only approach, one may discriminate true PGC from distal esophageal adenocarcinoma. This subset of patients is a mo re appropriate comparison group when analyzing outcome relative to pat ients with DGC. Methods A review of the prospective database for gastr ic adenocarcinoma at Memorial Sloan-Kettering Cancer Center between Ju ly 1985 and August 1995 identified 98 patients with PGC resection via a transabdominal-only approach. Of these, 65 underwent proximal gastre ctomy and 33 underwent total gastrectomy. For DGC, 258 required a dist al gastrectomy and 71 required total gastrectomy. Results The overall 5-year survival of patients with PGC was 42% (median survival, 47 mont hs), whereas the 5-year survival for patients with DGC was 61% (median survival, 106 months, p = 0.03). Within each stage, there were no sig nificant survival differences, but in ail stages, survival was better for patients with DGC. More important, the site of the primary tumor a ppears to affect survival, with a worse outcome as the tumor moves pro ximally. Conclusions Despite excluding distal esophageal cancers, surv ival for patients with PGC remains worse than for those with DGC. Late stage of presentation could not explain this difference. it appears t hat PGCs are inherently more aggressive than are DGCs. In addition, si te of the primary tumor appears to affect outcome, with a trend toward a worse outcome as the tumor moves proximally.