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March 16, 2009

Total Gastrectomy

Arch Surg. 2009;144(3):289-292. doi:10.1001/archsurg.2008.584

The article by Pacelli et al1 entitled “Four Hundred Consecutive Total Gastrectomies for Gastric Cancer: A Single-Institution Experience” that was published in the August 2008 issue of Archives raises the question of whether or not all patients with carcinoma of the stomach need total gastrectomy (TG) with D2/D3 node dissection and/or adjacent organ resection. Ever since Bilroth performed the first gastrectomy for carcinoma of the stomach,2 there has been controversy over whether TG or subtotal gastrectomy is the better option for this kind of cancer. Surgeons are convinced that radical subtotal excision for all tumors, “except very proximal tumor[s],”3 result in better overall short- and long-term results. Sasako et al2 recently reported the results of radical TG in a highly selected group of 199 of 523 patients. Their results showed that 5-year overall survival was 69.2% and 5-year disease-free survival was 62.6%, with an overall complication rate of 20.9%. In the series reported by Sasako et al, node-negative patients had a 5-year survival rate of 78.4% and a mortality rate of 0.8%, whereas in Pacelli and colleagues' series, the overall survival rate was 61% in the curative group and only 12.8% in the palliative group (the total overall survival rate was only 37.3%), the overall complication rate was 30.8%, and the overall mortality rate was 4.9%. Such inferior results are due to the fact that the authors performed radical TG in each subset of patients. It will be interesting to know the 5-year disease-free survival rate in their current series.

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