Surgical treatment of early cancer of the proximal third of the stomach

Pattern of lymph node involvement in proximal gastric cancer

BACKGROUND

The operative methods for proximal gastric cancer differ depending on the institution, thus there is no optimal therapeutic strategy. A splenic hilum lymph node (No. 10) dissection is necessary for D2 operation for proximal gastric cancer, which means it requires splenectomy. However, unnecessary splenectomy should be avoided.

METHODS

A total of 127 proximal gastric cancer cases from our institution were studied retrospectively. In addition, 1,569 cases were collected from the literature and were used as pooled data for further analysis. All cases were examined for the depth of tumor invasion and lymph node metastasis.

RESULTS

A retrospective analysis revealed that proximal gastric cancer within submucosa (40 cases) had no N2 lymph node metastasis in our study. The 5-year overall survival of all cases was 25.2% and the disease-free survival was 23.6%. From the pooled data analysis, No. 10 lymph node metastasis was observed in 0.9% of the patients with submucosa proximal gastric cancer. Furthermore, there was no No. 4d lymph node metastasis when the depth of cancer was limited to within the subserosa.

CONCLUSIONS

Although a randomized, controlled trial concerning survival is necessary, according to this study, there is a possibility that limited resection might be accepted for proximal gastric cancer according to the depth of wall invasion.

Adenocarcinoma of the gastroesophageal junction in Japan: relevance of Siewert's classification applied to 177 cases resected at a single institution

BACKGROUND

There had been a lack of international consensus about the definition of cancer of the gastric cardia until Siewert's classification was approved at a consensus conference during the second International Gastric Cancer Congress held in 1997.

STUDY DESIGN

A review of the prospective gastric cancer database at Aichi Cancer Center from 1983 to 1992 identified 1,913 gastric carcinoma patients who underwent gastrectomy. These patients were classified retrospectively according to the Siewert classification, and 177 patients who fell into one of the three types form the basis of this study. Survival analyses were performed after stratifying patients by clinicopathologic variables.

RESULTS

There were 33 patients with type II and 144 with type III, although none had type I, a type frequently observed in the west. No evidence of a change in the frequency of types II or III cancers (approximately 9.3% overall) among gastric carcinoma patients was observed over the 10-year period. Clinical staging of gastric carcinoma by the TNM classification was found to reflect accurately the prognosis of these patients. There were no longterm survivors among the few patients with metastasis to the perigastric nodes of the distal stomach.

CONCLUSIONS

A striking difference in the distribution of types of adenocarcinoma of the gastroesophageal junction was observed in Japan compared with previously reported western data. A subgroup of carcinoma of the proximal stomach identified as types II and III may not require proximal gastrectomy from the viewpoint of sufficient lymphadenectomy.