Total Gastrectomy for Gastric Cancer: 12-Year Data and Review of the Effect of Performing Lymphadenectomy

JINRYO TAKEDA; KIKUO KOUFUJI; ISSEI KODAMA; YOSHIAKI TSUJI; TOSHIO YOKOYAMA; SHINJI KAWABATA; TETSU SUEMATSU; TERUO KAKEGAWA

doi:10.2739/kurumemedj.41.15

JINRYO TAKEDA, KIKUO KOUFUJI, ISSEI KODAMA, YOSHIAKI TSUJI, TOSHIO YOKOYAMA, SHINJI KAWABATA, TETSU SUEMATSU, TERUO KAKEGAWA

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Keywords: gastric cancer, total gastrectomy, combined resection, extended lymphadenectomy, para-aortic lymph node, prognosis

JOURNAL FREE ACCESS

1994 Volume 41 Issue 1 Pages 15-21

DOI https://doi.org/10.2739/kurumemedj.41.15

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Abstract

A total of 1, 272 patients with gastric cancer were admitted to our institute for surgery during 12 years (1975-1986). Of these, 1, 059 (83.4%) underwent gastrectomy. Among these, 252 (23.8%) were total gastrectomy (TG), involving 160 (63.5%) cases of cancer mainly located in the upper third of the stomach, 81(32.1%) in the middle third and 11(4.4%) in the lower third. Radical TG was performed in 65.9% and palliative TG in 34.1%. Roux-en-Y reconstruction was selected in 80%, jejunal interposition in 17.6% and double tract in 2.4%. The survival rate was improved by introducing extended lymph node dissection, especially in the cases of stage III & IV cancer in which a combined pancreatico-splenectomy could lead to cure when associated with lymphadenectomy. In cases of a positive serosal exposure, the 5-year survival rate was increased by extended lymphadenectomy from 21% to 46% (p<0.02) . Anastomotic leakage occurred in 4.2%. The postoperative mortality rate was 1.6%, occurring in only 4 patients.

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