title: Total gastrectomy for gastric cancer: an analysis of postoperative and long-term outcomes through time: results of 413 consecutive cases in a single cancer center.
abstract: BACKGROUND
  Advanced gastric cancer in the upper or middle third of the stomach is routinely treated with a total gastrectomy, albeit in some cases with higher morbidity and mortality. The aim of this study was to describe the morbimortality and survival results in total gastrectomy in a single center.
  
  
  METHODS
  This retrospective study included patients with gastric adenocarcinoma treated with a total gastrectomy at a single Brazilian cancer center between January 1988 and December 2011. Clinical, surgical, and pathology information were analyzed through time, with three 8-year intervals being established. Prognostic factors for survival were evaluated only among the patients treated with curative intent.
  
  
  RESULTS
  The study comprised 413 individuals. Most were male and their median age was 59 years. The majority of patients had weight loss and were classified as American Society of Anesthesiologists 2. A curative resection was performed in 336 subjects and a palliative resection was performed in 77 subjects. Overall morbidity was 37.3% and 60-day mortality was 6.5%. Temporal analysis identified more advanced tumors in the first 8-year period along with differences in the surgical procedure, with more limited lymph node dissections. In addition, a significant decrease in mortality was observed, from 13 to 4%. With a median follow-up of 74 months among living patients, median survival was 56 months, and 5-year overall survival was 49.2%. Weight loss, lymphadenectomy, tumor size, and T and N stages were prognostic factors in multivariate analysis.
  
  
  CONCLUSIONS
  Total gastrectomy is a safe and feasible treatment in experienced hands. Advances in surgical technique and perioperative care have improved outcomes through time.
authors.affiliation: Department of Abdominal Surgery, A. C. Camargo Cancer Center, São Paulo, Brazil, wilson-luiz@uol.com.br.
authors.forename: Wilson Luiz
authors.initials: WL
authors.lastname: da Costa
authors.forename: Felipe J F
authors.initials: FJ
authors.lastname: Coimbra
authors.forename: Héber S C
authors.initials: HS
authors.lastname: Ribeiro
authors.forename: Alessandro L
authors.initials: AL
authors.lastname: Diniz
authors.forename: André Luís
authors.initials: AL
authors.lastname: de Godoy
authors.forename: Igor Correia
authors.initials: IC
authors.lastname: de Farias
authors.forename: Maria Dirlei F S
authors.initials: MD
authors.lastname: Begnami
authors.forename: Fernando Augusto
authors.initials: FA
authors.lastname: Soares
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D055815:Young Adult