Skip to main content

Advertisement

SpringerLink
Log in

Proximal Versus Distal Gastric Carcinoma—What Are the Differences?

  • Original Article
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background: The incidence of proximal gastric third carcinoma (PGC) has been rising in recent years. Classification and surgical therapy remain controversial.

Methods: Between May 1986 and October 1997, 532 patients were operated for primary gastric carcinoma. All patient data were analyzed retrospectively comparing findings in patients with PGC and those with distal gastric carcinoma (DGC).

Results: Two hundred fifty patients had a PGC, and 282 patients had a DGC. The rate of R0 resections was 79.3% for PGC and 81.6% for DGC. In 93.9% of the patients with PGC total gastrectomy was performed; for DGC total gastrectomy was done in 74.5% of patients. Postoperative morbidity and mortality were 29.2% for PGC and 23.8% for DGC, and 3.2% for PGC and 3.5% for DGC, respectively. Patients with advanced tumor stages (stage III and IV) were more common in the PGC group (73.3% vs. 53.6% in DGC). After R0 resection, the 5-year survival rate was 33.2% for PGC and 59.7% for DGC.

Conclusions: There was no significant difference between the rates of R0 resections for PGC and DGC. Total gastrectomy can be performed with low postoperative morbidity and mortality. PGC and DGC represent the same tumor entity, and prognosis is similar, but due to more advanced tumor stages, the long-term survival is worse for patients with PGC than for those with DGC. Left retroperitoneal lymphadenectomy may be indicated for PGC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Blot WJ, Devesa SS, Kneller RW, et al. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991;265:1287–1289.

    Google Scholar 

  2. Salvon-Harman JC, Cady B, Nikulasson S, et al. Shifting proportions of gastric adenocarcinomas. Arch Surg 1994;129:381–389.

    Google Scholar 

  3. Rhode H, Bauer P, Stützer H, et al. Proximal compared with distal adenocarcinoma of the stomach: differences and consequences. Br J Surg 1991;78:1242–1248.

    Google Scholar 

  4. Harrison LE, Karpeh MS, Brennan MF. Proximal gastric cancers resected via a transabdominal-only approach: results and comparisons to distal adenocarcinoma of the stomach. Ann Surg 1997;225:678–685.

    Google Scholar 

  5. Stark SP, Romberg MS, Pierce GE, et al. Transhiatal versus transthoracic esophagectomy for adenocarcinoma of the distal esophagus and cardia. Am J Surg 1996;171:478–482.

    Google Scholar 

  6. Cushieri A, Fayers P, Fielding J, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet 1996;347:995–999.

    Article  Google Scholar 

  7. Bonenkamp JJ, Songun I, Hermans J, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995;345:745–748.

    Article  CAS  PubMed  Google Scholar 

  8. Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg 1998;85:1457–1459.

    Article  CAS  PubMed  Google Scholar 

  9. Misumi A, Murakami A, Harada K, et al. Definition of the gastric cardia. Langenbecks Arch Chir 1989;374:221–226.

    Google Scholar 

  10. Siewert JR, Hölscher AH, Becker K, et al. Kardiakarzinom: Versuch einer therapeutisch relevanten Klassifikation. Chirurg 1987;58:25.

    CAS  Google Scholar 

  11. U ICC. TNM Classification of Malignant Tumors, 5th ed. Berlin: Springer Verlag, 1997.

    Google Scholar 

  12. Siewert JR, Böttcher K, Stein HJ, et al. Problem of proximal third gastric carcinoma. World J Surg 1995;19:523–531.

    Google Scholar 

  13. Harrison LE, Karpeh MS, Brennan MF. Total gastrectomy is not necessary for proximal gastric cancer. Surgery 1998;123:127–130.

    Google Scholar 

  14. Fein M, Fuchs KH, Ritter M, et al. Application of the new classification for cancer of the cardia. Surgery 1998;124:707–713.

    Google Scholar 

  15. Stipa S, Di Giorgio A, Ferri M. Surgical treatment of adenocarcinoma of the cardia. Surgery 1992;111:386–393.

    Google Scholar 

  16. Hsu CP, Wu CC, Chen CI, et al. Clinical experience in radical lymphadenectomy for adenocarcinoma of the gastric cardia. J Thorac Cardiovasc Surg 1997;114:544–551.

    Google Scholar 

  17. Hundahl SA, Menck HR, Mansour EG, et al. The National Cancer Data Base report on gastric carcinoma. Cancer 1997;80:2333–2341.

    Google Scholar 

  18. Jakl J, Miholic J, Koller R, et al. Prognostic factors in adenocarcinoma of the cardia. Am J Surg 1995;169:316–319.

    Google Scholar 

  19. Siewert JR, Böttcher K, Stein HJ, et al. Relevant prognostic factors in gastric cancer: ten-years results of the German Gastric Cancer Study. Ann Surg 1998;228:449–461.

    Google Scholar 

  20. Jaehne J, Meyer HJ, Maschek H, et al. Lymphadenectomy in gastric carcinoma—a prospective and prognostic study. Arch Surg 1992;127:290–294.

    Google Scholar 

  21. Sasako M. Risk factors for surgical treatment in the Dutch gastric cancer trial. Br J Surg 1997;84:1567–1571.

    Google Scholar 

  22. Maruyama K, Sasako M, Kinoshita T, et al. Pancreas preserving total gastrectomy for proximal gastric cancer. World J Surg 1995;19:532–536.

    Google Scholar 

  23. Kodera Y, Yamamura Y, Shimizu Y, et al. Lack of benefit of combined pancreatosplenectomy in D2 resection for proximal third gastric carcinoma. World J Surg 1997;21:622–628.

    Google Scholar 

  24. Meyer HJ, Ja¨hne J, Weimann A, et al. Chirurgische Therapie des Magenkarzinoms-Indikationen zur Splenektomie bei der Gastrektomie. Chirurg 1994;65:437–440.

    Google Scholar 

  25. Graham AJ, Finley RJ, Clifton JC, et al. Surgical management of adenocarcinoma of the cardia. Am J Surg 1998;175:418–421.

    Google Scholar 

  26. Schumpelik V, Drew B, Ophoff K, et al. Adenokarzinom des ösophagogastralen Überganges: Assoziation mit Barrett-Ösophagus und gastroösophagealer Refluxkrankheit—chirurgische Ergebnisse bei 122 Patienten. Leber Magen Darm 1996;26:75–786.

    Google Scholar 

  27. Lerut T, Coosemans W, Van Raemdonck D, et al. Surgical treatment of Barrett’s carcinoma—correlations between morphologic findings and prognosis. J Thorac Cardiovasc Surg 1994;107:1059–1066.

    Google Scholar 

  28. Yonemura Y, Tsugawa K, Fonseca L, et al. Lymph node metastasis and surgical management of gastric cancer invading the esophagus. Hepatogastroenterology 1995;42:37–42.

    Google Scholar 

  29. Sakaguchi T, Watanabe A, Sawada H, et al. Characteristics and clinical outcome of proximal-third gastric cancer. J Am Coll Surg 1998;187:352–357.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Viszeral und Transplantationschirurgie, Medizinische Hochschule Hannover, Germany

    Pompiliu Piso MD, Uwe Werner MD, Petrit Mirena MD & Jürgen Klempnauer MD

  2. Klinik für Allgemein und Transplantationschirurgie, Zentrum Chirurgie, Universita¨tsklinikum, Essen, Germany

    Hauke Lang MD

  3. Klinik für Viszeral und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl Neuberg Str. 1, 30625, Hannover, Germany

    Pompiliu Piso MD

Authors
  1. Pompiliu Piso MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uwe Werner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hauke Lang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Petrit Mirena MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jürgen Klempnauer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pompiliu Piso MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Piso, P., Werner, U., Lang, H. et al. Proximal Versus Distal Gastric Carcinoma—What Are the Differences?. Ann Surg Oncol 7, 520–525 (2000). https://doi.org/10.1007/s10434-000-0520-0

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10434-000-0520-0

Key Words

Search

Navigation