Objective: To evaluate total gastrectomy for the treatment of cancer of the cardia and stomach fundus.
Methods: Five hundred and thirteen patients with cancer of the cardia and stomach fundus underwent radical resection. Of them, 326 were treated using total gastrectomy (group TG); and 187, using proximal gastrectomy (group PG). The 5-year and 10-year survival rates and the postoperative complication rate and mortality rate were followed up and compared in the two groups.
Results: The 5-year and 10-year survival rates of group TG were 43.6% and 24.5%, of group PG were 33.9% and 14.1%, respectively, and the difference was statistically significant (chi(2) = 4.421, P < 0.05, chi(2) = 5.726, P < 0.05). The postoperative complication rate and mortality rate of group TG were 14.7% and 3.1%, of group PG were 10.2% and 2.1%, respectively, and the difference was not statistically significant (chi(2) = 1.796, P > 0.05, chi(2) = 0.082, P > 0.05).
Conclusions: To improve long-term therapeutic effects, total gastrectomy should be recommended for stage III patients with cancer of the cardia and stomach fundus when tumor size is bigger than 3.0 cm or lymph node metastasis occur. The postoperative complication rate and mortality rate should not be increased and the esophagitis of gastroesophageal reflux should be avoided in the patients treated using total gastrectomy.