Gastroenterology and Hepatology from Bed to Bench

Abstract

Aim:  This study aimed to compare the recurrence rate, mortality, and morbidity of curative resection of distal adenocarcinoma of the stomach between total gastrectomy (TG) and subtotal gastrectomy (STG).

Background: The choice between TG and STG for adenocarcinoma of the lower third of the stomach is still a matter of debate and controversy among surgeons.

Patients and methods: Hospital records of 66 patients with distal adenocarcinoma of stomach, which had undergone even-total or subtotal gastrectomy between October 2001 and February 2006 in Taleghani hospital, Iran were reviewed retrospectively. Demographic data and clinicopathological factors were recorded. Post-operative outcomes including mortality, morbidity and tumor recurrence were assessed. Univariate analyses using Fisher's exact test, the Student t-test, and the Pearson ?² test were used. P values less than 0.05 were considered statistically significant.

Results: Recurrence rate was higher in STG than TG (61% vs. 23%, RR=2.68, 95% CI=1.37-5.24, P=0.002). The mean time interval between gastrectomy and tumor recurrence was not different between TG and STG (19.75±5.1 vs. 18.0±7.8 months, P=0.507). Tumor size >5 cm (P=0.004), diffuse type (P=0.034), poor differentiation (P=0.001) and serosal invasion (P=0.012) were found to be significantly related to tumor recurrence in patients who had undergone gastrectomy.

Conclusion: Subtotal and total gastrectomy techniques have similar surgical outcome and postoperative complication rate; however, STG is associated with a more than twofold increase in local recurrence risk.