Open AccessSelection of Operative Procedure for Adenocarcinoma of the Midstomach Twenty Yearsʼ Experience with Implications for Future Treatment Strategy
Author(s) -
Man H. Shiu,
Dimitri N. Papacristou,
Cynthia Kosloff,
George M. Eliopoulos
Publication year - 1980
Publication title -
annals of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.153
H-Index - 309
eISSN - 1528-1140
pISSN - 0003-4932
DOI - 10.1097/00000658-198012000-00007
Subject(s) - medicine , gastrectomy , adenocarcinoma , stage (stratigraphy) , lymph , stomach , survival rate , lymphovascular invasion , gastric carcinoma , carcinoma , surgery , retrospective cohort study , cancer , metastasis , gastroenterology , pathology , paleontology , biology
Pathoanatomic studies of the regional spread of adenocarcinoma of the middle one-third of the stomach suggested the need for extensive gastric and lymphatic resection. To seek evidence of improved results, a retrospective study was made of 213 patients curatively treated by three commonly used procedures: 1) radical high subtotal gastrectomy (SG, n = 39), 2) radical total gastrectomy (TG, n = 48), and 3) extended total gastrectomy (ETG, n = 126). The overall five-year survival rates were SG:10%, TG:16%, and ETG:19%. Advanced stage tumors (N2, N3, or M1) were highly lethal, irrespective of the type of resection. However, patients with early stage tumors (T1-4, N0 or N1) showed higher survival rates after more extensive resections (ETG:42% and TG: six of eight patients, versus SG:17%). The highest survival rate (93%) was observed in a subset of patients with early stage tumors electively treated by ETG; this was achieved despite the presence of metastasis to the juxtagastric (N1) lymph nodes or direct invasion of an adjacent organ in most of these patients. These observations confirm the merit of extensive resection for carcinoma of the midstomach.