Total Versus Subtotal Gastrectomy for Adenocarcinoma of the Gastric Antrum

Abstract

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.

Results of Surgical Treatment of Gastric Cancer

“…The old argument that lymphadenectomy increases the surgical risk without improvement of survival [10, 13, 14]seems not to be valid today. The data on operative mortality of radical gastric resection shown here are low and are similar to other reports demonstrating that a D2 operation does not increase the surgical risk [15, 16].…”

Subtotal or total gastrectomy for gastric cancer: impact of the surgical procedure on morbidity and prognosis?analysis of a 10-year experience

“…In a study conducted by Meyer et al [12] over a follow-up period of 27 years, the authors observed a significant decrease in postoperative mortality at stable morbidity rates toward the end of the study period, despite the use of increasingly radical operative procedures for gastric carcinoma. While older studies found an increase in postoperative mortality after gastrectomy compared with the outcome after subtotal gastrectomy [13][14][15], Gouzi et al [16] did not observe a difference between the two resection procedures (1.3% after gastrectomy compared with 3.2% after subtotal resection) in a prospective randomised trial. Included in their study were, however, only selected patients with low comorbidity, whereas patients with specific risk factors were excluded from the study [16].…”

“…While older studies found an increase in postoperative mortality after gastrectomy compared with the outcome after subtotal gastrectomy [13][14][15], Gouzi et al [16] did not observe a difference between the two resection procedures (1.3% after gastrectomy compared with 3.2% after subtotal resection) in a prospective randomised trial. Included in their study were, however, only selected patients with low comorbidity, whereas patients with specific risk factors were excluded from the study [16]. Results obtained in a multicentre study performed by Bozzetti et al [17] in a total number of 618 patients who underwent either subtotal or total gastrectomy in conjunction with D2 lymphadenectomy showed, in concert with our findings, similar postoperative morbidity and mortality rates in patients after subtotal and total gastrectomy.…”

Lymph Node Dissection in Resectable Advanced Gastric Cancer

“…Comparable results were found in an observational German study (morbidity 23 vs. 47%) [10]. In a French study, no difference in 5-year survival was found between a total and subtotal gastric resection [11]. This was confirmed 10 years later in an Italian study [12].…”