Surgical outcome in patients with gastric adenocarcinoma in the upper third of the stomach.

BACKGROUND The incidence of carcinoma in the cardiac area of the stomach has been increasing, but the appropriate surgical strategy for these tumors remains controversial. Here we attempt to clarify the debate by retrospectively evaluating surgical outcome. METHODS A total of 191 patients were examined. Patients underwent potentially curative resection for gastric adenocarcinoma, primarily of the upper third of the stomach. Prognostic factors, patterns of lymph node metastasis, and the efficacy of lymphadenectomy were evaluated. RESULTS Univariate and multivariate analyses revealed lymph node metastasis as a prognostic factor in gastric cancer. Old and new indices of efficacy were the highest for lymph node removal along the lesser curvature, followed by the paracardial regions and along the left gastric and pancreatic arteries. Removal of the lateroaortic lymph node on the cranial side of the left renal vein had a relatively high efficacy index. In esophageal invasion, the efficacy of lower paraesophageal and supraphrenic lymph node removal was high, although there were discrepancies between the 2 indices. CONCLUSIONS The extent of lymphadenectomy should be tailored to tumor location. Lymphadenectomy might include the lateroaortic lymph nodes for advanced gastric cancer in the upper third of the stomach and the supradiaphragmatic and lower paraesophageal nodes for tumors extending to the esophagus. Randomized controlled trials are needed to verify these indices.