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Abstract:
One hundred and forty-four patients with gastric malignancy (98% adenocarcinoma) underwent curative resection (CR, 69 patients), palliative resection (PR, 55), or gastrojejunostomy (GJ, 20) between 1957 and 1978. Allocation to the CR or PR groups was according to the surgeon's intraoperative assessment. The extent of resection, mortality, complications, and postoperative ability to eat were reviewed in all patients. Palliation of preoperative symptoms, duration of palliation, and survival were recorded in 105 of 112 discharged and followed patients. GJ was accompanied by a 25% operative mortality rate and a 20% incidence of gastrointestinal complications. PR and CR partial or subtotal gastrectomy were associated with 15% and 21% mortality and 22% and 29% gastrointestinal complication rates, respectively. PR and CR total or proximal gastrectomy with esophagectomy were accompanied by 27% and 33% mortality and 33% and 48% gastrointestinal complications. These comparative values are not significantly different. Two thirds of all patients were able to resume a normal diet postoperatively. After GJ 80% of survivors obtained relief of preoperative symptoms for a mean interval of 5.9 months; none was alive at 1 year. After PR 88% of survivors experienced relief of symptoms for a significantly longer interval of 14.6 months (P < 0.01); 16% were alive at 2 years and 7% at 3 years. After CR 68% of survivors obtained satisfactory palliation of symptoms for a significantly longer interval of 47.6 months (P < 0.025); 47% were alive at 2 years and 38% were alive at 3 years, a significant (P < 0.01) improvement over the other two groups. Gastrojejunostomy provides less palliation of significantly shorter duration when compared to resection, without reduction of postoperative gastrointestinal complications or operative mortality. Curative resection significantly improves 3-year survival without increasing mortality, although gastrointestinal complications are more common with extended resection and esophageal anastomosis. Extension of resection in an attempt to cure is worthwhile because it prolongs survival, although with some risk of increased complications. Otherwise, resection of the major lesion is preferable to bypass in order to improve and prolong palliation.