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Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach?

Authors :
Masaru Hayami
Ken Namikawa
Takeshi Sano
Rie Makuuchi
Koshi Kumagai
Satoshi Ida
Manabu Ohashi
Motonari Ri
Shinichiro Atsumi
Souya Nunobe
Source :
Annals of Gastroenterological Surgery, Vol 5, Iss 6, Pp 767-775 (2021), Annals of Gastroenterological Surgery
Publication Year :
2021
Publisher :
Wiley, 2021.

Abstract

Aim To treat upper third gastric cancer, proximal gastrectomy (PG), a function‐preserving procedure, is recommended for early lesions when at least half the distal stomach can be preserved, while total gastrectomy (TG) is standard for locally advanced lesions. Oncological feasibility, when applying PG for such lesions, remains unknown. Methods We reviewed patients undergoing TG for clinical (c) T2–T4 upper third gastric cancer between 2006 and 2015. Preoperative tumor locations were further classified into the cardia, fornix, and gastric body based on endoscopic findings. The metastatic rate and therapeutic value index for lymph node (LN) dissection were determined, and characteristics of patients with distal LN (No. 4d, 5, and 6) metastasis (DLNM) were reviewed. In addition, patients with pathological tumor invasion to the middle third (M) region were investigated. Results We studied 167 patients. There were 8 (4.8%) with DLNM and 41 (24.6%) with pathological tumor invasion to the M region. As to regional stations, therapeutic indices for LN dissection at stations No. 4d, 5, 6, and 12a were zero or extremely low. No DLNM was detected in cT2 lesions or cT3/T4 lesions located within the cardia and/or the fornix. In addition, none of the lesions located within the cardia and/or the fornix by preoperative endoscopy extended to the M region in the pathological specimen. Conclusions For upper third gastric cancer, PG without No. 12a dissection might be acceptable for cT2–T4 lesions located within the cardia and/or the fornix when considering the risk of DLNM and cancer‐positivity in the distal stump.<br />The metastatic rate and therapeutic value index for distal lymph node (No. 4d, 5, and 6) were investigated in patients undergoing total gastrectomy for cT2–T4 upper third gastric cancer. In addition, pre‐ and postoperative tumor location was reviewed by preoperative endoscopy and the pathological specimen. For upper third gastric cancer, proximal gastrectomy might be acceptable for cT2–T4 lesions located within the cardia and/or the fornix when considering the risk of distal lymph node metastasis and cancer‐positivity in the distal stump.

Details

Language :
English
ISSN :
24750328
Volume :
5
Issue :
6
Database :
OpenAIRE
Journal :
Annals of Gastroenterological Surgery
Accession number :
edsair.doi.dedup.....49d0d9eef85e1ce0efc1cd74a8850948