抄録
The optimal extent of resection for proximal gastric adenocarcinoma is controversial. We evaluated a consecutive series of 214 patients to identify the best principal method of surgical therapy for resectable proximal gastric cancer and its longterm outcome. We focused on the relationships among the extent of gastric resection, the consequent duodenal passage (DFP) reconstruction and the type of postoperative adjuvant therapy. The patients underwent total or proximal gastrectomy between August 1974 and May 1997. They ranged in age from 28 to 80 years (median: 60 years), and 75.2% were men.
Among the patients at stage 1A or stage 4 gastric cancer, those who received subtotal rather than total gastrectomy had significantly better survival rates. Patients at stage 1A who received duodenal passage reconstruction also had significantly higher survival rates than those who did not receive it. Multivariate analysis revealed that DFP reconstruction and the extent of the gastric resection were significant independent prognostic factors for patients at all stages. In patients who underwent gastrectomy alone without postoperative therapy the extent of the gastric resection was an independent prognostic. On the other hand, in patients who underwent either proximal or total gastrectomy followed by postoperative adjuvant therapy, DFP reconstruction was an independent prognostic factor. Though the actual mechanism underlying this is unclear, our findings indicate that surgeons dealing with proximal gastric cancer must take into consideration the relationships among the extent of gastric resection, DFPR and the type of postoperative adjuvant therapy.
