Total Gastrectomy for Gastric Cancer: 12-Year Data and Review of the Effect of Performing Lymphadenectomy.

Abstract

Summary: A total of 1,272 patients with gastric cancer were admitted to our institute for surgery during 12 years (1975)(1976)(1977)(1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986). Of these, 1,059 (83.4%) underwent gastrectomy. Among these, 252 (23.8%) were total gastrectomy (TG), involving 160 (63.5%) cases of cancer mainly located in the upper third of the stomach, 81(32.1%) in the middle third and 11(4.4%) in the lower third. Radical TG was performed in 65.9% and palliative TG in 34.1%. Roux-en-Y reconstruction was selected in 80%, jejunal interposition in 17.6% and double tract in 2.4%. The survival rate was improved by introducing extended lymph node dissection, especially in the cases of stage III & IV cancer in which a combined pancreaticosplenectomy could lead to cure when associated with lymphadenectomy. In cases of a positive serosal exposure, the 5-year survival rate was increased by extended lymphadenectomy from 21% to 46% (p<0.02) . Anastomotic leakage occurred in 4.2%. The postoperative mortality rate was 1.6%, occurring in only 4 patients.

Gastric Cancer

“…This procedure has been standard practice in many Japanese centers for several years. Though no randomized prospective trials from the Japanese exist comparing D2 resections to more limited D1 resections, retrospective analysis from Japan has shown increases in 5-year survival using the more extended D2 resection [14,15]). This benefit was primarily limited to those patients with serosal invasion of tumor.…”