[Partial versus total gastrectomy in the surgical treatment of stomach cancer].
The authors discuss some aspects of radical gastrectomy. They analyse whether there is any progress in their results in the treatment of stomach cancer in the past 5 years. They describe some aspects of total gastrectomy with regards to the need for splenectomy. During 36 years (01.07.1952-30.06.1962 and 1974-1999) 1614 patients were treated for stomach cancer. In the last two 5 year long periods (1990-1994 and 1995-1999) the number of radical operations was 106 and 114. In the second period we used laparoscopic exploration in some patients. We carried out total gastrectomies with modern suturing devices (AutoSuture Premium Plus CEEA, Proximate ILS Straight Intraluminal Stapler Endo Surgery, TA Premium) without compromising the principles of radicality using Rochard-Aesculap retractor in most patients. We tried to avoid splenectomy when possible. In the past 5 years we carried out lymphadenectomy according to the Japanese classification, excising group I and II lymph nodes. The resectability rate rose in the last 6 years compared to the previous ten year period (55.3%, 36.1%, 48.4%, 64.3%). The ratio of total gastrectomies increased from 8.6% (10 out of 106 resections) to 42.9% (49 out of 114 resections) in the two 5 year periods. Mortality for partial and total gastrectomy were 4.6% (65/3) and 6.1% (49/3). They could preserve the spleen in 32.6% of the cases. We found that laparoscopic exploration rarely influenced the operation. Partial resection in intestinal type stomach cancer should be performed, if a margin of 6 cm can be achieved. If the patient is in good general health, total gastrectomy should be performed unless the size, type and lymph node involvement of the cancer indicated otherwise. We think that increased resectability is related to both increased capabilities and better diagnostic tools. It is important to preserve the spleen where oncology principals allow.
Márkus
B
B
Vas Megye és Szombathely Megyei Jogú Város Markusovszky Kórháza, Egyetemi Oktatókórház, Altalános Sebészeti Osztály, 9700 Szombathely, Markusovszky u. 3.
Pintér
G
G
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013528:Surgical Staplers; D016896:Treatment Outcome