Comparison of results of surgery in the upper third and more distal stomach.

The results of surgery for gastric cancer in the upper third of the stomach and the more distal region were compared to explain the comparatively poor outcomes in the former. Characteristics and therapeutic results of 1245 patients who underwent curative gastrectomy (244 with tumors in the upper third of the stomach and 1001 with more distal cancers) were compared. Survival was significantly lower in patients with cancer of the upper third of the stomach than in patients with more distal cancers. There was a significant difference between the two groups in the survival of patients with advanced gastric cancer, particularly in those with pN1. Among patients with tumors deeper than T2 and pN1, survival was significantly reduced in those aged <or=75 years with tumors in the upper third of the stomach that were macroscopically ill defined, histologically undifferentiated, and showed venous invasion. Hematogenous recurrence was more frequent in patients with tumors deeper than T2 and pN1 in the upper third of the stomach. Tumors in the upper third of the stomach and venous invasion independently predicted hematogenous recurrence. Treatments for T2 or deeper and pN1 tumors in the upper third of the stomach, particularly for hematogenous metastasis, require further investigation.