Comparative study between total gastrectomy and subtotal gastrectomy for treatment of gastric cancer

The authors present a comparative study between subtotal and total gastrectomy with and without lymphadenectomy, analysing the morbidity and mortality as well as survival of the different groups, relating them to the site of the tumour and TNM staging. Two hundred and nine patients operated on for carcinoma of the stomach were analysed, 158 of whom corresponded to retrospective studies, 72 subtotal gastrectomies and 79 total gastrectomies with a mean 5-year survival of 16.66 and 16.76 months respectively. A comparison is made with the prospective group of 51 patients to whom total gastrectomy plus resection of the spleen and body and tail of the pancreas was performed, associated with regional lymphadenectomy relating lymph node spread with tumour location. The mortality rate for the three groups was 11.1% for subtotal gastrectomy, 11.1% for total gastrectomy and 7.8% for total gastrectomy plus lymphadenectomy. The mean survival rate in months shows no difference for stage I and is greater after gastrectomy plus lymphadenectomy in the remainder: 37.5% for stage II, 26.7% for stage III and 21.6% for stage IV. The cause of the difference is analysed and it is concluded that gastrectomy associated with lymph node resection performed by a trained team is the technique of choice for gastric cancer.