Surgical strategy for upper a third gastric cancer in 191 patients

Objective: To investigate the rational scope of resection in treatment of the upper third gastric cancer.Methods: The clinical data of 191 patients undergoing radical resection for upper third gastric adenocarcinoma were analyzed and the efficacy of lymphadenectomy for the groups of the lymph nodes were evaluated.Results: The index of efficacy was the highest for lymph node removal in the paracardial regions,followed by along the left gastric artery,along the pancreatic artery,along the left renal vein and along the abdominal aorta.Removal of the lateroaortic lymph node on the cranial side of the left renal vein had a relatively ligh efficacy index.In patients with the esophagus involved,the efficacy of lower paraesophageal and supraphrenic lymph node removal was high.Conclusions: The scope of lymphadenectomy should be tailored to tumor location.The 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.