Total gastrectomy for gastric cancer: 12-year data and review of the effect of performing lymphadenectomy.
A total of 1,272 patients with gastric cancer were admitted to our institute for surgery during 12 years (1975-1986). Of these, 1,059 (83.4%) underwent gastrectomy. Among these, 252 (23.8%) were total gastrectomy (TG), involving 160 (63.5%) cases of cancer mainly located in the upper third of the stomach, 81 (32.1%) in the middle third and 11 (4.4%) in the lower third. Radical TG was performed in 65.9% and palliative TG in 34.1%. Roux-en-Y reconstruction was selected in 80%, jejunal interposition in 17.6% and double tract in 2.4%. The survival rate was improved by introducing extended lymph node dissection, especially in the cases of stage III & IV cancer in which a combined pancreatico-splenectomy could lead to cure when associated with lymphadenectomy. In cases of a positive serosal exposure, the 5-year survival rate was increased by extended lymphadenectomy from 21% to 46% (p < 0.02). Anastomotic leakage occurred in 4.2%. The postoperative mortality rate was 1.6%, occurring in only 4 patients.
Takeda
J
J
Department of Surgery, Kurume University School of Medicine, Japan.
Koufuji
K
K
Kodama
I
I
Tsuji
Y
Y
Yokoyama
T
T
Kawabata
S
S
Suematsu
T
T
Kakegawa
T
T
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate