Proximal third gastric adenocarcinoma: Results of total gastrectomy by general surgeons and analysis of prognostic factors

Surgical results and prognostic factors were studied in a total of a consecutive 121 patients following total gastrectomy, without routine thoracotomy for proximal third gastric adenocarcinoma, with surgery performed between 1986 and 1992. Laparotomy was used as the first approach in all patients. Exposure of lower mediastinum was helped by incising or resecting the diaphragm around the esophageal hiatus; therefore thoracotomy was performed in only 14 (11.6%) patients. Curative resection requiring lymph node dissection up to the second echelon (D2) and free resection margin was done for 65 (53.7%) patients. Positive esophageal margin was left in 18 (14.9%) patients who, except for two, underwent palliative resection. The postoperative complication rate was 16.5% with operative mortality in five patients (14.1%). The overall cumulative five-year survival rate was 33.5%. Multivariate analysis indicated that the most important prognostic factors were distant metastasis, esophageal invasion, serosal invasion and lymph node metastasis. Positive resection margins were not independent factors. It was concluded that earlier detection before distant metastasis and esophageal invasion is important in improving the results of total gastrectomy for proximal third gastric cancer and a comparable result can be achieved without routine thoracotomy.