Total and proximal gastrectomy in the treatment of gastric carcinoma: A series of 305 cases

Abstract

AbstractA total of 305 total or proximal gastrectomies for gastric carcinoma were performed in 291 patients. Of the tumors 51.5% were of the intestinal‐type and 35.7% were of the diffuse‐type of carcinoma. Proximal gastrectomy was performed in 68 patients, total gastrectomy in 230, and anastomotic resection in 7. In 25 patients a reresection for recurrent carcinoma was performed. After total gastrectomy the main reconstructive procedures were end‐to‐side esophago‐jejunostomy and Roux‐en‐Y esophagojejunostomy. The hospital mortality rate was 13.4%. The main causes of death were anastomotic leakage and pulmonary embolism. The incidence of leakage was 10.8% and the complication proved fatal in 36.4% of the patients who developed it. After Roux‐en‐Y reconstruction only 8% of the patients with leakage died. After curative operations 27% of the patients survived for over 5 years (relative survival rate of 33%). The 5‐year survival rates for the intestinal‐type and diffusetype of carcinoma were similar, but the 10‐year survival rate for intestinal‐type of carcinoma was significantly better. In our view a relatively high mortality rate after total or proximal gastrectomy has to be accepted when older patients are concerned, and when no other curative procedure is possible on account of the site and extent of invasion of the tumor. However, in cases where radical resection can be achieved by means of subtotal gastrectomy, this method is best. At present, in cases of the diffuse‐type of carcinoma of the corpus, we perform a total gastrectomy instead of subtotal gastrectomy. In the small series of reresections the results were encouraging.