Pattern of surgical treatment for early gastric cancers in upper third of the stomach.

BACKGROUND/AIMS: Various surgical treatments are indicated for early gastric cancers in upper third of the stomach (U-EGC) because of its anatomical property and favorable prognosis.

METHODOLOGY

Five hundred and eighty six cases of U-EGCs were collected for 9 years from 19 hospitals in Japan. Surgical procedures were classified as total (TG) and proximal gastrectomy (PG), and the latter was subclassified as esophagogastrostomy (PG-EG) and jejunal interposition (PG-JI) reconstruction.

RESULTS

TG was more frequent than PG (76.3% vs. 21.8%, p<0.0001). PG was more frequently performed in high volume hospitals than in low volume hospitals (26.8% vs. 10.2%, p<0.0001), however there were still large difference in frequency of PG even among high volume hospitals, ranging from 5.0% to 72.0%. For reconstruction after PG, PG-EG and PG-JI were representatively performed in 50 (39.1%) and 35 (27.3%) patients. Each institute tended to preferentially employ either PG-EG or PG-JI. Tumor size was significantly larger in TG than in PG (38.8mm vs. 22.3mm, p<0.0001) and diffuse type tended to be more frequent in TG as well.

CONCLUSIONS

There is a huge variety of surgical treatment for U-ECG in general hospitals in our country. A multi-institutional large cohort randomized trial might be urgent to establish the standard surgical procedure of this infrequent disease.