Abstract
Because gastric cancers located in the upper third of the stomach are difficult to detect at an early stage, the surgical results remain poor. We performed R4 gastrectomy as a radical procedure for 25 patients, involving complete resection of the latero-aortic and interaorticovenous lymph modes above and below the left renal vein, in combination with the ordinary R2 or R3 gastrectomy (the R4 group). These patients were compared with 156 others who underwent R2 gastrectomy alone (the R2 group). There were no significant differences in operation time, blood loss, or the incidence of complications between the two groups; however, when the survival rates of the patients with tumors invading beyond the subserosa were compared, the 5-year survival rate was found to be significantly higher in the R4 group than in the R2 group. Furthermore, in patients with para-aortic nodal involvement, a significant survival advantage was observed in the R4 group, as compared with the R2 group. These results suggest that the R4 gastrectomy is a rational approach for patients with advanced gastric cancer located in the upper third of the stomach.
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References
Herberer G, Teichman RK, Kramling HJ, Gunther B (1988) Results of gastric resection for carcinoma of the stomach: The European experience. World J Surg 12:374–381
Dent DM, Madden MW, Price SK (1988) Randomized comparizon of RI and R2 gastrectomy for gastric carcinoma. Br J Surg 75:110–112
Irvin TT, Bridger JE (1988) Gastric cancer: an audit of 122 consecutive cases and the results of R1 gastrectomy. Br J Surg 75:106–109
Furukawa H, Hiratsuka M, Imanaga T (1988) A rational technique for surgical operation on Borrmann type 4 gastric carcinoma: left upper abdominal evisceration plus Appleby's method. Br J Surg 75:116–119
Maruyama K, Gunven P, Okabayashi K, Sasako M, Kinoshita T (1989) Lymph node metastases of gastric cancer. Ann Surg 210:596–602
Yonemura Y, Ooyama S, Matumoto H, Kamata T, Kimura H, Takegawa S, Kosaka T, Yamaguchi A, Miwa K, Miyazaki I (1991) Pancreaticoduodenectomy in combination with right hemicolectomy for surgical treatment of advanced gastric carcinoma located in the lower half of the stomach. Int J Surg 76:226–229
Allum WH, Hallissey MT, Kelly K (1989) Adjuvant chemotherapy in operable gastric cancer. Lancet 18:571–574
Maruyama K, Okabayashi K, Kinoshita T (1987) Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 11:418–425
Yonemura Y, Katayama K, Kamata T, Fushida S, Segawa M, Ohyama S, Miwa K, Miyazaki I (1991) Surgical treatment of advanced gastric cancer with metastasis in para-aortic lymph node. Int J Surg 76:222–225
Oohashi I, Kajitani T (1986) Radical operation for advanced upper gastric cancer (in Japanese). In: Gastric Cancer Surgery (The Latest Therapy), vol 3. Igaku Kyouiku Shuppan, Tokyo, pp 344–350
Japanese, Research Society for Gastric Cancer (1981) The general rules for the gastric cancer study in surgery and pathology. Jpn J Surg 11:127–139
Spiessl B, Beahrs OH, Hermanek P, Hutter RVP, Scheibe O, Sobin LH, Wagner G (eds) (1990) TNM Atlas; Illustration guide to the TNM/pTNM classification of malignant tumours, 3rd ed. (UICC) Springer Berlin Heidelberg
Shiu MH, Moore E, Sanders M, Huvos A, Freedman B, Goodbold J, Chaiyaphruk S, Wesdorp R, Brennan MF (1987) Influence of the extent of resection on survival after curative treatment of gastric carcinoma. Arch Surg 122:1347–1351
Keigley MRB, Moore J, Roginski C, Powell J, Thompson H (1984) Incidence and prognosis of N4 node involvement in gastric cancer. Br J Surg 71:863–866
Takahashi S, Takahashi T, Sawai K, Hagiwara A, Tokuda H, Kato G, Takenaka A (1987) Studies on para-aortic metastatic lymph nodes of gastric cancer after endoscopic injection of activated carbon particles. Jpn J Surg 88:35–39
Yonemura Y, Miyazaki I (1989) Surgical techniques and clinical significance of the radical lymphadenectomy against para-aortic lymph nodes in advanced gastric cancer (in Japanese). Rinsyou Geka 44:777–784
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Yonemura, Y., Segawa, M., Matsumoto, H. et al. Surgical results of performing R4 gastrectomy for gastric cancer located in the upper third of the stomach. Surg Today 24, 488–493 (1994). https://doi.org/10.1007/BF01884566
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DOI: https://doi.org/10.1007/BF01884566