OBJECTIVETo investigate the reasonable surgical approach for upper gastric cancer, surgical technique, and indications for combined resection of the spleen.

METHODSEight hundred and three patients with upper gastric cancer were operated in the Cancer Center of Sun Yat-Sen from December 1964 to December 2004, including 341 cases undergoing abdominal incision and 462 thoracotomy or abdomino-thoracic incision. Clinical data were analyzed retrospectively.

RESULTSThe operative time was significantly shorter in the abdominal incision group (170 vs. 220 min, P<0.01), as was the transfusion volume (200 vs. 650 ml, P<0.05). Positive resection margin was similar between the two groups (5.6% vs. 6.7%, P>0.05). There was no difference in overall postoperative complication rate (3.2% vs. 5.0%, P>0.05). Length of hospital stay was shorter in the abdominal incision group (21 vs. 26.6 days, P<0.05).

CONCLUSIONSelection of surgical approach should be based on the tumor characteristics. Abdominal incision should be the approach of choice where possible.