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  • Title: Advanced gastric cancer in the middle one-third of the stomach: Should surgeons perform total gastrectomy?
    Author: Jang YJ, Park MS, Kim JH, Park SS, Park SH, Kim SJ, Kim CS, Mok YJ.
    Journal: J Surg Oncol; 2010 May 01; 101(6):451-6. PubMed ID: 19924722.
    Abstract:
    BACKGROUND AND OBJECTIVES: To determine which optimal surgical procedure for middle-third advanced gastric cancer (AGC) based on comparative study of the long-term prognosis between total gastrectomy (TG) and distal gastrectomy (DG). METHODS: Between March 1993 and December 2005, 402 patients with middle-third AGC who underwent gastric resection were enrolled in this study. We analyzed the long-term prognosis according to the length of the proximal resection margin (PRM) and the extent of gastric resection, and determined independent prognostic factors. RESULTS: TG was performed in 244 patients (60.7%) and DG was performed in 158 patients (39.3%). There were no significant differences in the 5-year survival rates according to the length of PRM. The 5-year survival rates of patients who underwent DG were significantly higher than the rates of the patients who underwent TG in curative cases (67.8% vs. 58.4%, P = 0.037). Nevertheless, there was no significant difference in the stage-stratified survival rates according to the extent of gastric resection. Multivariate analysis revealed that surgical curability, extent of lymphadenectomy, and stage were independent prognostic factors. CONCLUSION: If curative resection can be performed, the long-term prognosis of patients with middle-third AGC was not affected by the length of PRM or the extent of gastric resection.
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