J Gastric Cancer.  2010 Dec;10(4):226-233.

Which Is the Optimal Extent of Resection in Middle Third Gastric Cancer between Total Gastrectomy and Subtotal Gastrectomy?

• Lee JH
• Kim YI

Abstract

PURPOSE
In resectable gastric cancer, choice regarding the extent of resection depends on tumor size, location, and distance from resection margin. However, there remains controversy for choice of resection for tumors in the middle third of the stomach. This study investigated patients who underwent gastrectomy in order to analyze the differences between total gastrectomy (TG) and subtotal gastrectomy (STG).
MATERIALS AND METHODS
From 2000 to 2006, 125 patients with a tumor in the middle third of the stomach underwent radical gastric resection at EUMC. We retrospectively conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between TG and STG.
RESULTS
The average tumor size was 6.7 cm for TG, and 4.1 cm for STG. The number of metastatic lymph nodes were 13.3 for TG, and 3.7 for STG. Patients with more advanced cancer were more likely to receive TG. The 5-year survival rate for TG was lower (38.1%) than STG (69.0%). However, if tumor stages were stratified, there was no significant difference in the survival rate. Histologically, for the undifferentiated type of cancer (Stage 1, 2), the 5-year survival rate of STG was higher (88.1%) than TG (75.0%).
CONCLUSIONS
Comparing patients with tumors in the middle third of the stomach who underwent TG and STG, there was no statistically significant difference in the 5-year survival rate. If stages were stratified, the clinicopathological characteristic becomes a key factor in deciding the prognosis, rather than the choice of resection. Thus if the radical resection margin can be obtained for a tumor in the middle third of the stomach, STG is considered instead of TG.

Keyword

Gastric neoplasms; Gastrectomy; Prognosis

MeSH Terms

Gastrectomy
Humans
Lymph Nodes
Prognosis
Retrospective Studies
Stomach
Stomach Neoplasms
Survival Rate

Figure

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  Fig. 1 Overall survival rate of patients after TG and STG of mid-third gastric cancer. TG = total gastrectomy; STG = subtotal gastrectomy.

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  Fig. 2 Stage-stratified (7th UlCC) 5 year-survival analysis for patients after TG and STG of mid-third gastric cancer. (A) Stage 1, 2 (B) Stage 3, 4. STG = subtotal gastrectomy; TG = total gastrectomy; UICC = Union for International Cancer Control.

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