Subtotal Gastrectomy or ‘en principle’ Total Gastrectomy in Cancer of the Lower Half of the Stomach

Abstract

Background: There is still a matter of controversy whether a subtotal gastrectomy has the same therapeutic potential as a total gastrectomy in distal gastric cancer. Whether all or a subgroup of patients can benefit from total gastrectomy can be answered only by a randomized trial. Method: We therefore assembled a prospective randomized multi-institutional trial which has so far randomized 400 patients for total or subtotal gastrectomy and second level lymphadenectomy. Material: Patients with gastric carcinoma of the lower half of the stomach are eligible unless one of the following conditions exists: Age over 75 years, previous malignant neoplasia except skin cancer, previous gastric resection, high surgical risk, tumor located at less than six centimeters from cardia, tumors not radically resectable. Results: The accrual of patients is still in progress. The available results concern the mortality rate that is higher after total gastrectomy but not statistically different from subtotal resection.

The Historical Perspective of Gastric Cancer

“…Meanwhile, in the case of curative resection, subtotal stomach resection and gastrectomy-allowing for the principles of radicalism-do not show prognostic differences any more [34]; more attention is being paid to quality of life as an indicator of successful surgery. Hereby, subtotal gastric resection is generally understood as the more physiological procedure, supported by postoperative gastrectomy diagnostic findings such as the Dumping Syndrome, postprandial flatulence or pain, and hungry [35].…”