Proximal gastric cancers resected via a transabdominal-only approach. Results and comparisons to distal adenocarcinoma of the stomach

The purpose of this study is to compare the outcome of patients with proximal gastric cancer (PGC) treated by a transabdominal-only resection to that of patients with distal gastric cancer (DGC). It has been suggested that PGC is inherently more aggressive than DGC. The worse survival of PGC compared with that of DGC may be in part, because of the difficulty distinguishing PGC from distal esophageal adenocarcinoma. By defining a subset of PGC resected using an transabdominal-only approach, one may discriminate true PGC from distal esophageal adenocarcinoma. This subset of patients is a more appropriate comparison group when analyzing outcome relative to patients with DGC. A review of the prospective database for gastric adenocarcinoma at Memorial Sloan-Kettering Cancer Center between July 1985 and August 1995 identified 98 patients with PGC resection via a transabdominal-only approach. Of these, 65 underwent proximal gastrectomy and 33 underwent total gastrectomy. For DGC, 258 required a distal gastrectomy and 71 required total gastrectomy. The overall 5-year survival of patients with PGC was 42% (median survival, 47 months), whereas the 5-year survival for patients with DGC was 61% (median survival, 106 months, p = 0.03). Within each stage, there were no significant survival differences, but in all stages, survival was better for patients with DGC. More important, the site of the primary tumor appears to affect survival, with a worse outcome as the tumor moves proximally. Despite excluding distal esophageal cancers, survival for patients with PGC remains worse than for those with DGC. Late stage of presentation could not explain this difference. It appears that PGCs are inherently more aggressive than are DGCs. In addition, site of the primary tumor appears to affect outcome, with a trend toward a worse outcome as the tumor moves proximally.