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Article
October 1988

Total Gastrectomy and Survival

Arch Surg. 1988;123(10):1286. doi:10.1001/archsurg.1988.01400340112021

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Abstract

To the Editor.—We would like to comment on the recent article by Shiu and coworkers.1

Multivariate analysis is a powerful tool in the evaluation of retrospective data in a field where prospective studies have not been undertaken, and this article should therefore be welcomed. We have, however, doubts whether total gastrectomy per se has an adverse influence on survival, as the authors contend. We suspect that significant variables not considered in this series are masked by the risk factor "total gastrectomy" in the Cox model. The inclusion of "tumor size" in the multivariate analysis is not sufficient proof for the independence of "total gastrectomy."

In the final Cox model (Table 41), no variables show up that represent the extent of the tumor as "tumor size" or TNM stage. These variables correlate highly with "total gastrectomy," rendering the question unsolved whether total gastrectomy or rather the more advanced

References
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Shiu MH, Moore E, Sanders M, et al:  Influence of the extent of resection on survival after curative treatment of gastric carcinoma: A retrospective multivariate analysis . Arch Surg 1987;122:1347-1351.Article
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Bozzetti F, Bonfanti G, Buralino R, et al:  Adequacy of margins of resection in gastrectomy for cancer . Ann Surg 1982;196:685-690.Article
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Horning D, Hermanek P, Gall FP:  The significance of the extent of proximal margins of clearance in gastric cancer surgery . Scand J Gastroenterol 1987;22( (suppl 133) ):69-71.Article
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Kirchner R, Henke W, Wittekind C, et al:  The surgeons' estimation of radicality and results of pathologic examination of margins of resection in gastric cancer surgery . Scand J Surg 1987;22( (suppl 133) ):72-75.
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Papachristou DN, Karas M, Fortner JG:  Anastomotic recurrence in the oesophagus complicating gastrectomy for adenocarcinoma of the stomach . Br J Surg 1979;66:609.Article
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