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The current TNM classification usually understages these tumors because it does not take the partly retroperitoneal location of the proximal stomach into account. After correction of the TNM classification a proximal tumor location has no influence on survival. Because these tumors benefit most from radical lymph node dissection, the retroperitoneal lymphatic drainage must be taken into account when performing lymphadenectomy for proximal third gastric cancer. To avoid pancreatic fistulas and the associated morbidity, a pancreas\u2010preserving splenectomy and lymphadenectomy should be adapted if an extended lymph node resection of the retroperitoneum is performed. Because of the high prevalence of \u201cintestinal type\u201d tumors in the proximal third of the stomach the extent of the luminal resection margins can be limited; that is, a total gastrectomy with transhiatal resection of the distal esophagus usually suffices to achieve complete tumor removal at the oral margin.<\/jats:p>","DOI":"10.1007\/bf00294713","type":"journal-article","created":{"date-parts":[[2004,10,6]],"date-time":"2004-10-06T08:54:55Z","timestamp":1097052895000},"page":"523-531","source":"Crossref","is-referenced-by-count":77,"title":["Problem of proximal third gastric carcinoma"],"prefix":"10.1002","volume":"19","author":[{"given":"J. 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