We performed a retrospective review of 30 patients with esophagogastric adenocarcinoma who underwent surgical treatment in our hospital between 2000-2005, and discussed the survival impact of total gastrectmoy, splenectomy, and mediastinal lymphadenectomy through thoracotomy. In our series, splenectomy and mediastinal lymphadenectomy through thoracotomy did not improve survival for advanced type II and type III tumors. Most patients with lymphnode metastases at lower mediastinum and/or the superior border of the pancreas along the splenic artery toward the splenic hilum had concurrent para-aortic node metastasis, and their prognosis was extremely poor. Taken together, we have reached the conclusion that the appropriate surgical treatment for type II and type III advanced tumors is total gastrectomy with D2 lymphadenectomy through abdominal approach.
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