Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach?
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...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-11-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12486 |
| _version_ | 1818925087068258304 |
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| author | Motonari Ri Koshi Kumagai Ken Namikawa Shinichiro Atsumi Masaru Hayami Rie Makuuchi Satoshi Ida Manabu Ohashi Takeshi Sano Souya Nunobe |
| author_facet | Motonari Ri Koshi Kumagai Ken Namikawa Shinichiro Atsumi Masaru Hayami Rie Makuuchi Satoshi Ida Manabu Ohashi Takeshi Sano Souya Nunobe |
| author_sort | Motonari Ri |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T02:35:38Z |
| format | Article |
| id | doaj.art-d4c33a6391ad4cbabf1eb88b1d1a9c5d |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-12-20T02:35:38Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-d4c33a6391ad4cbabf1eb88b1d1a9c5d2022-12-21T19:56:27ZengWileyAnnals of Gastroenterological Surgery2475-03282021-11-015676777510.1002/ags3.12486Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach?Motonari Ri0Koshi Kumagai1Ken Namikawa2Shinichiro Atsumi3Masaru Hayami4Rie Makuuchi5Satoshi Ida6Manabu Ohashi7Takeshi Sano8Souya Nunobe9Department of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterology Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanDepartment of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer Research Tokyo JapanAbstract 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.https://doi.org/10.1002/ags3.12486distal marginlocally advanced gastric cancerlymph node metastasisproximal gastrectomytherapeutic indexupper third gastric cancer |
| spellingShingle | Motonari Ri Koshi Kumagai Ken Namikawa Shinichiro Atsumi Masaru Hayami Rie Makuuchi Satoshi Ida Manabu Ohashi Takeshi Sano Souya Nunobe Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? Annals of Gastroenterological Surgery distal margin locally advanced gastric cancer lymph node metastasis proximal gastrectomy therapeutic index upper third gastric cancer |
| title | Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? |
| title_full | Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? |
| title_fullStr | Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? |
| title_full_unstemmed | Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? |
| title_short | Is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach? |
| title_sort | is proximal gastrectomy indicated for locally advanced cancer in the upper third of the stomach |
| topic | distal margin locally advanced gastric cancer lymph node metastasis proximal gastrectomy therapeutic index upper third gastric cancer |
| url | https://doi.org/10.1002/ags3.12486 |
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