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Advanced gastric cancer in the middle one‐third of the stomach: Should surgenos perform total gastrectomy?
Author(s) -
Jang YouJin,
Park ManSik,
Kim JongHan,
Park SungSoo,
Park SeungHeum,
Kim SeungJoo,
Kim ChongSuk,
Mok YoungJae
Publication year - 2009
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21431
Subject(s) - medicine , gastrectomy , resection margin , lymphadenectomy , multivariate analysis , stomach , surgical margin , cancer , stage (stratigraphy) , gastroenterology , surgery , resection , paleontology , biology
Background and Objectives To determine which optimal surgical procedure for middle‐third advanced gastric cancer (AGC) based on comparative study of the long‐term prognosis between total gastrectomy (TG) and distal gastrectomy (DG). Methods Between March 1993 and December 2005, 402 patients with middle‐third AGC who underwent gastric resection were enrolled in this study. We analyzed the long‐term prognosis according to the length of the proximal resection margin (PRM) and the extent of gastric resection, and determined independent prognostic factors. Results TG was performed in 244 patients (60.7%) and DG was performed in 158 patients (39.3%). There were no significant differences in the 5‐year survival rates according to the length of PRM. The 5‐year survival rates of patients who underwent DG were significantly higher than the rates of the patients who underwent TG in curative cases (67.8% vs. 58.4%, P = 0.037). Nevertheless, there was no significant difference in the stage‐stratified survival rates according to the extent of gastric resection. Multivariate analysis revealed that surgical curability, extent of lymphadenectomy, and stage were independent prognostic factors. Conclusion If curative resection can be performed, the long‐term prognosis of patients with middle‐third AGC was not affected by the length of PRM or the extent of gastric resection. J. Surg. Oncol. 2010; 101:451–456. © 2009 Wiley‐Liss, Inc.