In a multicentric trial the postoperative mortality and the 5-year survival of elective total gastrectomy (TG) was compared with subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated on with intent of cure. Two hundred and one patients were included in the study; 32 were excluded after pathologic examination (linitis plastica, superficial cancer, lymphoma). One hundred sixty-nine patients remained for analysis, with 93 undergoing TG and 76 undergoing SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no difference in the 5-year survival rate (48%). Analysis of survival showed no difference in the two techniques when related to nodal involvement and serosal extension. It is concluded that both TG and SG can be performed safely in patients with adenocarcinoma of the antrum; however TG did not increase the survival rate.
A multicentric randomized trial conducted by the French Associations for Surgical Research tested total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated with curative intent, in terms of postoperative mortality and 5-year survival. TG was performed in 76 patients and 93 patients underwent SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no statistical difference between the two techniques with regard to 5-year survival (48%). These results were reviewed according to the most recent controversies reported in the literature, i.e. the radicality in lymph node resection enabled by each of the two procedures, the required proximal free margins in SG, the long-term risk of a gastric stump and the nutritional consequences of each technique.
Diffuse esophageal leiomyomatosis is a rare disorder which may be found in association with leiomyomas in other locations or with other disorders. We report two cases in men, one with associated tracheobronchial involvement, which illustrate the value of imaging in differentiating this entity from other causes of dysphagia and in establishing a diagnosis.
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