OBJECTIVETo study the best style of operation in the treatment of tumor invades adjacent structures (T(4)) cancer of the cardia and stomach fundus.

METHODSTwo hundred and one patients with T(4) cancer of the cardia and stomach fundus underwent operation. Of them, 31 were treated by laparotomy, and 170 by combined resection of the involved organs. The 3- and 5-year survival rates and the postoperative complication rate and mortality rate were analyzed in the patients who had under gone combined resection of the involved organs.

RESULTSThe median survival of the patients undergoing combined resection of the involved organs (29.3 months) was significantly longer than that of those receiving laparotomy (4.9 months). The 3- and 5-year survival rates of 170 patients who had under gone combined resection of the involved organs were 46.2% and 22.8%, respectively. The 3- and 5-year survival rates of patients undergoing total gastrectomy and proximal gastrectomy were 54.9% and 29.2% and 32.2% and 12.5%, respectively, and the difference was statistically significant (chi(2) = 7.589, P < 0.01;chi(2) = 5.792, P < 0.05).The postoperative mortality rate and complication rate were 4.1% and 24.1%, respectively.

CONCLUSIONSThe patients without liver metastasis, widespread nodal involvement, peritoneal dissemination and local focus allowed by an en bloc combined resection in T(4) cancer of cardia and stomach fundus should undergo gastrectomy with a combined resection of the involved organs. Total gastrectomy should be performed to improve the curative effect.