Total gastrectomy for gastric carcinoma

Gastric cancer is one of the most common organ cancers all around the world and surgical resection is essential for treatment. Total gastrectomy is the procedure of choice for treatment of proximal gastric cancer. Mortality and morbidity risks of this procedure are high, especially among the elderly.

Thirty-eight gastric cancer patients underwent total gastrectomy in the Third Surgical Clinic of Izmir Ataturk Training and Research Hospital between 1996 and 2001. Age, gender, location of the tumor, histopathological findings, TNM stage, type of anastomosis, operation time, blood transfusions, oral food intake, postoperative hospital stay, morbidity, mortality both early and late, and survival rate were evaluated.

Mean age of the patients was 59.5 years (22-85 years). Sites of the tumors were: cardia 28.9%, cardia and corpus 15.8%, corpus 34.3%, corpus and antrum 18.4%, linitis plastica 2.6%. Histological types were adenocarcinoma (97.4%), and squamous cell carcinoma (2.6%). TNM stages were: stage la 2.6%, stage II 7.9%, stage IIIa 39.5%, stage IIIb 42.1%, and stage IV 7.9%. Esophagojejunostomies were performed manually (34.3%) or by circular staplers (65.7%). Operation time ranged between 3 and 6.5 hours. Gastric tubes were removed on the fourth postoperative day. Average postoperative hospital stay was 12.9 days. Postoperative morbidity was 21%. Wound infection occurred in three patients (7.9%), pulmonary infection occurred in two patients (5.2%) and anastomotic stricture developed in three patients (7.9%). Hospital mortality was 20%. Anastomotic leak occurred in five cases (13.2%) and all died on days 8, 13, 14, 26, and 30. Three patients (7.9%) died of cardiac complications on days 1, 5, and 29. Twelve patients survived for less than one year and eight patients survived for one to two years. Average survival was 10.5 months for 20 out of 30 patients (median 8 months). Ten patients are still alive after 14.3 months. Four patients have been living for less than one year, another four patients for one to two years, and two patients for more than two years.

Total gastrectomy, either performed with a curative or palliative aim, is a safe procedure with acceptable mortality rates. 89.5% of our cases were stage III or IV resulting in a low survival rate. Longer survival rates can be achieved in patients with comparatively earlier stages.