Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group.
OBJECTIVE
To evaluate the impact of subtotal (SG) versus total (TG) gastrectomy on the oncologic outcome of patients with cancer of the distal stomach from 28 Italian institutions.


BACKGROUND
There is controversy over whether SG and TG have a different impact on the 5-year survival probability of patients with cancer of the distal half of the stomach.


METHODS
The present analysis involved 618 patients randomized during surgery to SG (315) or TG (303), provided there was at least 6 cm from the proximal edge of the tumor to the cardia, there was no intrapertoneal or distant spread, and it was possible to remove the tumor entirely. Both surgical treatments included regional lymphadenectomy.


RESULTS
Four patients died after SG and seven after TG. Median follow-up was 72 months after SG (range 2 to 125) and 75 months after TG (range 7 to 113). Five-year survival probability as computed by the Kaplan-Meier method was 65.3% for SG and 62.4% for TG. The test of equivalence led to the conclusion that the two procedures may be considered equivalent in terms of 5-year survival probability. The analysis of survival using a multivariate Cox regression model showed a statistically significant impact on survival of tumor site, tumor spread within the gastric wall, extent of resection to the spleen plus or minus neighboring organs or structures, and relative frequency of metastasis in resected lymph nodes.


CONCLUSIONS
Both procedures have a similar survival probability. The authors believe that SG, which has been reported to be associated with a better nutritional status and quality of life, should be the procedure of choice, provided that the proximal margin of the resection falls in healthy tissue.
Bozzetti
F
F
Istituto Nazionale per lo Studio e la Cura dei Tumori, Università degli Studi di Milano, Milan, Italy.
Marubini
E
E
Bonfanti
G
G
Miceli
R
R
Piano
C
C
Gennari
L
L
D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors