PROBLEM OF PROXIMAL 3RD GASTRIC-CARCINOMA

被引:83
作者
SIEWERT, JR [1 ]
BOTTCHER, K [1 ]
STEIN, HJ [1 ]
RODER, JD [1 ]
BUSCH, R [1 ]
机构
[1] TECH UNIV MUNICH,KLINIKUM RECHTS ISAR,INST MED STAT & EPIDEMIOL,D-81675 MUNICH,GERMANY
关键词
D O I
10.1007/BF00294713
中图分类号
R61 [外科手术学];
学科分类号
摘要
The prevalence of proximal third gastric carcinoma increases rapidly in the Western world. An analysis of prognostic factors indicates that the poor prognosis usually associated with these tumors is due at least in part to late presentation and advanced tumor stages. The current TNM classification usually understages these tumors because it does not take the partly retroperitoneal location of the proximal stomach into account. After correction of the TNM classification a proximal tumor location has no influence on survival. Because these tumors benefit most from radical lymph node dissection, the retroperitoneal lymphatic drainage must be taken into account when performing lymphadenectomy for proximal third gastric cancer. To avoid pancreatic fistulas and the associated morbidity, a pancreas-preserving splenectomy and lymphadenectomy should be adapted if an extended lymph node resection of the retroperitoneum is performed. Because of the high prevalence of ''intestinal type'' tumors in the proximal third of the stomach the extent of the luminal resection margins can be limited; that is, a total gastrectomy with transhiatal resection of the distal esophagus usually suffices to achieve complete tumor removal at the oral margin.
引用
收藏
页码:523 / 531
页数:9
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