Subtotal or total gastrectomy for gastric cancer: impact of the surgical procedure on morbidity and prognosis--analysis of a 10-year experience

Against the background of the continuing controversy as to the surgical procedure of choice for gastric cancer, the aim of the present study was to evaluate perioperative morbidity, prognostic factors of survival, and long-term survival after subtotal, abdominal and abdominothoracic gastrectomy in patients with gastric cancer. Between January 1993 and December 2002, 338 consecutive patients underwent surgery for adenocarcinoma of the stomach. Subtotal gastrectomy was carried out in 80 (23.7%) patients; 240 (71.0%) patients had abdominal gastrectomy, and 18 (5.3%) underwent abdominothoracic gastrectomy. At an overall 30-day mortality of 3.6% (hospital mortality, 5.2%), the total complication rate was 16.3%. The estimated 5-year survival rate was 43% in patients after subtotal gastrectomy, 39% in patients with abdominal gastrectomy, and 28% in patients with abdominothoracic gastrectomy after complete tumour clearance, without significant differences between the groups. Patients who underwent left pancreatectomy and had a higher ratio of metastatic/dissected lymph nodes were characterised by a significantly poorer prognosis. The lower morbidity and mortality rate with a nearly identical long-term survival yielded by subtotal gastrectomy compared with total gastrectomy leads us to justify subtotal gastrectomy, especially in elderly patients with comorbidity and a high operative risk, on the condition that its performance is radical from an oncological point of view.