Comparison of total versus subtotal gastrectomy for remnant gastric cancer

Completion gastrectomy (CG) is a common procedure for remnant gastric cancer (RGC). However, partial gastrectomy for gastric cancer has several benefits compared to total gastrectomy in terms of the quality of life. In this study, we evaluated the feasibility and advantage of subtotal resection of the remnant stomach (SR) for clinical stage IA RGC.

A total of 43 patients who underwent gastrectomy for clinical stage IA RGC were included. CG and SR were performed on 27 (62.8%) and 16 patients (37.2%), respectively. The short- and long-term outcomes, including the nutritional status, after CG and SR for clinical stage IA RGC were compared between the two groups.

There were no significant differences in pathological stage or incidence of postoperative complications between the two groups. The decrease in body weight, body mass index, and serum albumin level was significantly lower in the SR group than in the CG group (P < 0.001, P = 0.025, and 0.008). In the SR group, there was no recurrence at the remaining lymph nodes or gastric stump. The 5-year overall survival rate was 87.8% in the CG group and 86.1% in the SR group, without a significant difference between the two groups (P = 0.959).

The present study showed the noninferiority of SR to CG based on surgical and oncological outcomes for clinical stage IA RGC. Furthermore, SR has an advantage over CG in terms of postoperative nutritional status. Therefore, SR could be an alternative elective treatment option for early RGC located around the anastomotic site.