Abstract
Background
Against the background of the continuing controversy as to the surgical procedure of choice for gastric cancer, the aim of the present study was to evaluate perioperative morbidity, prognostic factors of survival, and long-term survival after subtotal, abdominal and abdominothoracic gastrectomy in patients with gastric cancer.
Patients and methods
Between January 1993 and December 2002, 338 consecutive patients underwent surgery for adenocarcinoma of the stomach. Subtotal gastrectomy was carried out in 80 (23.7%) patients; 240 (71.0%) patients had abdominal gastrectomy, and 18 (5.3%) underwent abdominothoracic gastrectomy.
Results
At an overall 30-day mortality of 3.6% (hospital mortality, 5.2%), the total complication rate was 16.3%. The estimated 5-year survival rate was 43% in patients after subtotal gastrectomy, 39% in patients with abdominal gastrectomy, and 28% in patients with abdominothoracic gastrectomy after complete tumour clearance, without significant differences between the groups. Patients who underwent left pancreatectomy and had a higher ratio of metastatic/dissected lymph nodes were characterised by a significantly poorer prognosis.
Conclusion
The lower morbidity and mortality rate with a nearly identical long-term survival yielded by subtotal gastrectomy compared with total gastrectomy leads us to justify subtotal gastrectomy, especially in elderly patients with comorbidity and a high operative risk, on the condition that its performance is radical from an oncological point of view.
Similar content being viewed by others
References
Adams JF (1967) The clinical and metabolic consequences of total gastrectomy, I: morbidity, weight and nutrition. Scand J Gastroenterol 2:137–144
Bradley EL, Isaacs JT, DelMazo J, Hersh T, Chey WU (1977) Pathophysiology and significance of malabsorption after Roux-en-Y reconstruction. Surgery 81:684–691
Herfarth C, Schlag P, Buhl K (1987) Surgical procedures for gastric substitution. World J Surg 11:689–698
Roukos DH (1999) Current advances and changes in treatment strategy may improve survival and quality of life in patients with potential curable gastric cancer. Ann Surg Oncol 6:46–56
Meyer HJ, Jahne J, Wilke H, Pichlmayr R (1991) Surgical treatment of gastric cancer: retrospective survey of 1704 operated cases with special reference to total gastrectomy as the operation of choice. Sem Surg Oncol 7:356–364
Papachristou DN, Fortner JG (1982) Choice of operative procedure for adenocarcinoma of the gastric antrum: a study based on TNM classification. J Surg Oncol 21:241–244
Bozzetti F (1992) Total versus subtotal gastrectomy in cancer of the distal stomach: facts and fantasy. Eur J Surg Oncol 18:572–579
Gennari L, Bozzetti F, Bonfanti G, Morabito A, Bufalino R, Doci R, Andreola S (1986) Subtotal versus total gastrectomy for cancer of the lower two-thirds of the stomach: a new approach to an old problem. Br J Surg 73:534–538
Svedlund J, Sullivan M, Liedman B, Lundell L (1999) Long term consequences of gastrectomy for patient’s quality of life: the impact of reconstructive techniques. Am J Gastroenterol 94:438–445
Roviello F, Marrelli D, De Stefano A, Messano A, Pinto E, Carli A (1998) Complications after surgery for gastric cancer in patients aged over 80 years and older. Jpn J Clin Oncol 28:116–122
Liedman BL, Bennegard K, Olbe LC, Lundell LR (1995) Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas. Eur J Surg 161:173–180
Meyer C, Rohr S, Vix J, De Manzini N, Bourtoul C, Thiry LC (1997) Outcome of surgical treatment of cancer of the stomach: report of 330 cases. Chir Ital 49:27–33
Adashek K, Sanger J, Longmire WP (1979) Cancer of the stomach: review of consecutive ten-year intervals. Ann Surg 189:6–10
Lortat-Jakob JL, Giuli R, Estenne B, Clot PH (1975) Interet de la gastrectomie totale pour le traitement des cancers de l’estomac: etude de 482 interventions radicales. Chirurgie 101:59–67
White RR, Mackie JA, Fitts WT (1975) An analysis of twenty years’ experience with operations for carcinoma of the stomach. Ann Surg 181:611–615
Gouzi JL, Huguier M, Fagniez PL, Launois B, Flamanz Y, Lacaine F, Paquet JC, Hay JM (1989) Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum: a French prospective study. Ann Surg 209:162–166
Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, Gennari L (1997) Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group. Ann Surg 226:613–620
Böttcher K, Siewert JR, Roder JD, Busch R, Hermanek P, Meyer HJ (1994) Risiko der chirurgischen Therapie des Magenkarzinoms in Deutschland. Chirurg 65:298–306
Griffith JP, Sue-Ling HM, Martin I, Dixon MF, McMahon MJ, Axon ATR, Johnston D (1995) Preservation of the spleen improves survival after radical surgery for gastric cancer. Gut 36:684–690
Brady MS, Rogatko A, Dent LL, Shiu MH (1991) Effect of splenectomy on morbidity and survival following curative gastrectomy for gastric carcinoma. Arch Surg 126:359–364
Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JTM, van Elk P, Obertop H, Gouma DJ, Taat CW, van Lanschot J, Meyer S, de Graaf PW, von Meyenfeldt MF, Tilanus H, van de Velde CJH (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748
Jatzko GR, Lisborg PH, Denk H, Klimpfinger M, Stettner HM (1995) A 10-year experience with Japanese-type radical lymph node dissection for gastric cancer outside of Japan. Cancer 76:1302–1312
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet 347:995–999
Svedlund J, Sullivan M, Liedman B, Lundell L, Sjödin I (1997) Quality of life after gastrectomy for gastric carcinoma: controlled study of reconstructive procedures. World J Surg 21:422–433
Schumacher IK, Hunsicker A, Petermann J, Lorenz D (1999) Magenkarzinomchirurgie—Bewährtes und Kontroverses. Retrospektive 10-Jahres-Analyse mit Diskussion aktueller Aspekte. Chirurg 70:1447–1453
Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L, The Italian Gastrointestinal Tumor Study Group (1999) Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomised Italian trial. Ann Surg 230:170–178
Marubini E, Bonfanti G, Bozzetti F, Boracchi P, Amadori D, Folli S, Nanni O, Gennari L (1993) A prognostic score for patients resected for gastric cancer. Eur J Cancer 29:845–850
Meyer C, Lozach P, Rohr S, Topar P, Youssef C, French Association of Surgery (2002) Gastric cancer: the French survey. Acta Gastroenterol Belg 65:161–165
Sanchez-Bueno F, Garcia-Marcilla JA, Perez-Flores D, Perez-Abad J, Vicente R, Aranda F, Ramirez P, Parrilla P (1998) Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection. Br J Surg 85:255–260
Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffith J, Miller G, Martin I (1998) Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg 22:1048–1055
Jentschura D, Winkler M, Strohmeier N, Rumstadt B, Hagmuller E (1997) Quality-of-life after curative surgery for gastric cancer: a comparison between total gastrectomy and subtotal gastric resection. Hepatogastroenterology 44:1137–1142
Braga M, Molinari M, Zuliani W, Foppa L, Gianotti L, Radaelli G, Cristallo M, Di Carlo V (1996) Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life. A prospective ten-year study. Hepatogastroenterology 43:187–193
Korenaga D, Orita H, Okuyama T, Moriguchi S, Maehara Y, Sugimachi K (1992) Quality of life after gastrectomy in patients with carcinoma of the stomach. Br J Surg 79:248–250
Larsson J, Akerlind I, Permerth J, Hörnqvist JO (1994) The relation between nutritional state and quality of life in surgical patients. Eur J Surg 160:329–334
Gockel I, Pietzka S, Junginger T (2004) Quality of life after subtotal resection and gastrectomy for gastric cancer. Chirurg 17 (Epub ahead of print)
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gockel, I., Pietzka, S., Gönner, U. et al. Subtotal or total gastrectomy for gastric cancer: impact of the surgical procedure on morbidity and prognosis—analysis of a 10-year experience. Langenbecks Arch Surg 390, 148–155 (2005). https://doi.org/10.1007/s00423-005-0544-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-005-0544-9