Total gastrectomy is not always necessary for advanced gastric cancer of the cardia

Background. It is unclear whether total gastrectomy (TG) is always necessary for gastric cancer of the cardia. We therefore investigated whether cardiac cancers treated by TG would have been cured by proximal gastrectomy (PG). Methods: Photocopies of the resected stomachs of 55 patients who had received TG for cardiac cancer were reviewed. A simulated resection line for PG was drawn connecting a point 5 cm from the pyloric ring on the lesser curvature with a point 15 cm from the pyloric ring on the greater curvature. The distal surgical margin between the tumor edge and the simulated resection line was measured, and lymph nodes (LN) dissected surgically were examined for tumor involvement. Results: Tumor location fell into three categories, upper-middle (UM, n = 28), upper (U, n = 18), and upper-esophagus (UE, n = 9). The means of the simulated surgical margins were 1.0 cm for UM, 4.7 cm for U, and 5.7 cm for UE tumors. UE tumors had no metastasis to No. 4d, 5, or 6 LN, and only one U tumor showed metastasis to No. 4d and 5 LN. In contrast, UM tumors had a higher incidence of these nodes involved. Conclusion: Advanced gastric cancer located in the U or UE regions is mostly curable by PG. Copyright (C) 2002 S. Karger AG, Basel.