INDICATION OF FUNCTION PRESERVING GASTRECTOMY FOR CANCER OF THE UPPER PART OF THE STOMACH

Abstract

One hundred and forty-seven cases undergoing resection for cancer of the upper stomach were reviewed, to determine the indications for conservative or function preserving operation. 1) In 11 cases with No. 4d, 5, and 6 metastases, their tumors were all S(+), extending to ss and beyond, and over 6cm in diameter except for 1 case of cancer 2.7cm in diameter (lesion on the greater curvature, No. 4d metastasis). 2) Relationship between lymph node metastasis of cancer in C region and tumor diameter was examined, which revealed that the incidence of metastasis was significantly lower for tumor under 4cm in diameter (8.0%) than for tumors over 4cm (71.1%), and the lymph nodes involved were all n1 with the former except for the said lesion on the greater curvature. 3) In 9 S0 cases among 17 cases of advanced cancer under 4cm in diameter, the depth of invasion was pm in 7 cases and se in 2 cases. From these data, it would seem that proximal gastrectomy is indicated in early tumors and advanced S0 tumors less than 4cm in diameter of C region exclusive of lesions on the greater curvature. However, ρ interposition with the pylorus left intact, in which No. 4d and the more frequently involved No. 3 nodes are removed, was judged better for the advanced cancer.