Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life. A prospective ten year study.
OBJECTIVE
The objective of this prospective study was to compare the results of total (TG) versus subtotal (SG) gastrectomy in patients with adenocarcinoma of the lower two-thirds of the stomach.


METHODS
Two hundred and twenty-seven patients underwent curative operation. Preoperative nutritional assessment, postoperative tumor stage, postoperative morbidity/mortality, five-year survival, postgastrectomy dietary intake and nutritional sequelae were recorded in all patients.


RESULTS
Postoperative mortality rate was 2.8% in the TG group and 1.1% in the SG group. The number of reoperations, anastomotic dehiscence rate and the length of postoperative stay were higher in the TG group. Five-year survival was closely related to lymph node involvement and gastric wall invasion. The extent of gastric resection did not influence survival when patients were matched for cancer stage. In the SG group, no recurrence in the gastric stump was observed. SG group showed a higher dietary energy intake than the TG group (p < 0.01). This might explain the ability of the SG group to increase body weight more than the TG group (p < 0.01). Only the TG group needed a monthly parenteral vitamin B12 supplements starting 36 months after surgery.


CONCLUSIONS
The results suggest that SG should be considered the treatment of choice of the gastric adenocarcinoma when a cancer-free proximal resection margin can be guaranteed.
Braga
M
M
Department of Surgery, Scientific institute San Raffaele, Italy.
Molinari
M
M
Zuliani
W
W
Foppa
L
L
Gianotti
L
L
Radaelli
G
G
Cristallo
M
M
Di Carlo
V
V
D000230:Adenocarcinoma / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009747:Nutritional Physiological Phenomena; D011446:Prospective Studies; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery*; D015996:Survival Rate