[Indications for total gastrectomy combined with pancreaticosplenectomy in the treatment of middle gastric cancer].

Of 1725 patients with middle gastric cancer (M, MA, MC) on whom radical surgery was performed (except for absolute non-curative resection) from 1960 to 1984 at the Cancer Institute Hospital, 238 patients in whom total gastrectomy or proximal partial gastrectomy combined with pancreaticosplenectomy was carried out, were submitted for both clinico-pathological and prognostic examination. The following results were obtained: 1. There are few indications for total gastrectomy plus pancreaticosplenectomy in patients with middle gastric cancer in which the lesions are superficial or semi-superficial. 2. For patients in whom the cancer occupies portions of the greater curvature, on posterior wall of the stomach, the whole stomach, or is of a non-localized type, the metastatic rate of lymph nodes No (10) or lymph nodes No (11) is high, then total gastrectomy plus pancreaticosplenectomy should be considered. 3. Lymph nodes No (2), (4d), (4sb) (7) and (9) can be good indices indicating presence or absence of metastasis of lymph nodes No (10) and lymph nodes No (11). 4. Radical surgery as well as effective adjuvant therapy are required for gastric cancer with invasion of the serosa.