[Gastrectomy de nécessité].

According to the principle "gastrectomie de nécessité" a total gastrectomy may have to be performed when the distance between the proximal edge of the tumour and the cardia is less than an adequate margin of security. The main reason for advocating this principle is that a large number of patients (ca. 20%) can profit by the advantages of a partial resection above all concerning the nutritional status and the quality of life. Against this principle it is argued that in the presence of a diffuse type carcinoma the risk of local recurrence is considerably higher.