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Gastric carcinoma: is radical gastrectomy worth while?
Annals of the Royal College of Surgeons of England
|January 1, 1980
Summary
Subtotal gastric resection is recommended over total gastrectomy for most gastric cancers. While total gastrectomy has a high mortality and poor survival, subtotal resection offers better outcomes and fewer side effects.
Area of Science:
- Surgical Oncology
- Gastroenterology
Background:
- Historically, total gastrectomy was considered for gastric carcinoma.
- Concerns arose regarding high operative mortality, lower survival rates, and significant digestive side effects compared to subtotal resection.
Purpose of the Study:
- To evaluate the efficacy and outcomes of total gastrectomy versus subtotal resection for gastric cancer.
- To compare operative mortality, 5-year survival rates, and post-gastrectomy sequelae.
Main Methods:
- Review of historical data from 1945-1955 on total gastrectomy.
- Analysis of 15 reports from 8 countries on recent gastric cancer treatment trends.
- Comparison of outcomes between total gastrectomy and subtotal resection techniques.
Main Results:
- Total gastrectomy exhibited higher operative mortality and lower 5-year survival rates.
- Radical subtotal resections with minimal gastric remnants also led to significant post-gastrectomy symptoms.
- Recent data shows total gastrectomy in 25.4% of resections with 21.7% mortality and 12.3% 5-year survival.
Conclusions:
- Subtotal resection, particularly distal to the vasa brevia preserving the gastric fundus and spleen, is recommended for typical antral gastric cancer.
- Total gastrectomy or radical resection is reserved for specific conditions.
- While technical refinements have reduced sequelae, they have not eliminated them.