Dr Badruddoja's letter raises many questions. First, there is currently no controversy regarding the choice between TG and partial gastrectomy for gastric cancer. Total gastrectomy is actually the treatment of choice for upper gastric cancer and middle gastric cancer, in which a proximal 5-cm disease-free margin cannot be obtained.
Lower cancers and those located in the middle, where it is possible to achieve a 5-cm proximal margin, are best treated with a distal subtotal gastrectomy.1 Given its retrospective nature, our study (which encompass a long period of time) also includes a group of patients with antral cancer who underwent, during the early years of our experience, the so-called de principe TG, which was subsequently abandoned.
Pacelli F, Rosa F, Doglietto GB. Total Gastrectomy—Reply. Arch Surg. 2009;144(3):289-292. doi:10.1001/archsurg.2008.585