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A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer
C S Robertson1, S C Chung, S D Woods
1Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
Annals of Surgery
|August 1, 1994
Summary
Radical surgery with extended lymphadenectomy (R3 total gastrectomy) did not improve survival for gastric antrum cancer compared to less extensive surgery (R1 subtotal gastrectomy). R3 gastrectomy led to higher morbidity and complications.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Clinical Research
Background:
- Gastric cancer survival rates remain suboptimal.
- The benefits of radical surgical approaches, including lymphadenectomy, are debated.
- Potential explanations for improved outcomes in some studies include differences in early cancer detection or patient demographics.
Purpose of the Study:
- To evaluate if a more radical surgical approach improves outcomes in patients with gastric antrum adenocarcinoma.
- To compare the efficacy and safety of R1 subtotal gastrectomy versus R3 total gastrectomy with extended lymphadenectomy.
Main Methods:
- A prospective, randomized controlled trial was conducted.
- Patients with gastric antrum adenocarcinoma were randomized to either R1 subtotal gastrectomy or R3 total gastrectomy.
- R3 gastrectomy involved extensive lymphadenectomy and organ resection.
Main Results:
- The R3 group experienced longer operating times, greater transfusion needs, and longer hospital stays.
- A higher incidence of postoperative complications, including intra-abdominal sepsis and subphrenic abscesses, was observed in the R3 group.
- Overall survival was significantly better in the R1 subtotal gastrectomy group.
Conclusions:
- While R3 total gastrectomy can be performed with low mortality, it is associated with significant morbidity, particularly from intra-abdominal sepsis.
- The routine use of R3 total gastrectomy for antral cancer is not supported by these findings.
- Less radical R1 subtotal gastrectomy demonstrated superior survival outcomes in this patient cohort.