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PubMed1997

Quality of life of patients with gastric adenocarcinoma after curative gastrectomy.

Quality of life (QOL) was evaluated in 162 patients having radical gastrectomy for cancer. The results showed that more than half of the patients had a good appetite; they consumed a normal diet and a normal volume of food. Approximately 60% of the patients had weight loss of more than 5 kg. Patients who underwent a total gastrectomy had poor tolerance of normal food and frequent eating and body weight loss versus those who had a subtotal gastrectomy. Patients who underwent Billroth II reconstruction after a distal subtotal gastrectomy lost more body weight than those with a Billroth I anastomosis. The extent of lymphadenectomy did not influence the QOL. Patients under 65 years of age had a better QOL. Nearly all patients had normal work and daily living activities. Some patients appeared to lack energy or had a period of anxiety or depression. These data indicate that radical gastrectomy can be performed with an acceptable QOL for a potentially curable gastric carcinoma.

Activities of Daily Living↗
PubMed2000

Anastomotic diameters and strictures following esophagectomy and total gastrectomy in 256 patients.

The prevalence of anastomotic strictures in esophageal anastomoses provides us with limited information about the anastomotic healing process. This prospective study evaluates the exact esophageal anastomotic diameters in 256 patients who underwent esophagectomy and esophagogastrostomy without pyloroplasty (n = 107) or total gastrectomy and Roux reconstruction (n = 149). No perioperative chemoradiotherapy was given. Anastomotic strictures and diameters were assessed during endoscopy by a separately inserted (inflated to the anastomotic width) balloon catheter. The anastomotic diameters increased significantly during the first postoperative year in the esophagectomy (p = 0.001) and gastrectomy (p < 0.001) groups. The anastomoses in the gastrectomy group were significantly wider than those in the esophagectomy group 3 (25.7 versus 19.9 mm), 6 (28.5 versus 22.0 mm), and 12 (30.5 versus 23.3 mm) months after surgery (p < 0.001). Neither the anastomotic site (neck or chest) in the esophagectomy group (p = 0.176) nor that in the gastrectomy group (abdomen or chest) (p = 0.577) influenced the anastomotic diameter. Benign anastomotic strictures were most frequently found after 3 months and after esophagectomy. Esophagojejunostomies performed with 2 linear stapling devices or cartridge size 28 mm showed the widest anastomoses with only 1 stricture. Esophagogastric anastomoses following esophagectomy are narrower and develop more strictures than esophagojejunal anastomoses after total gastrectomy, but both dilate during the first year.

Adult↗
PubMed2005

Intraoperative tumor localization using laparoscopic ultrasonography in laparoscopic-assisted gastrectomy.

BACKGROUND: During laparoscopic-assisted gastrectomy, it is impossible to identify early gastric cancer (EGC) lesions; therefore, a precise localization technique is needed. In this study, we used laparoscopic ultrasonography (LUS) after endoscopic clipping as a method of localizing EGC and evaluated the effectiveness of this method. METHODS: A prospective study of 17 patients who had undergone laparoscopic-assisted gastrectomy was performed. Three endoscopic clips were applied just proximal to the tumor during the preoperative endoscopy. The applied clips were detected from the serosal side of the stomach using LUS. The serosal surface of the lesion was marked with dye. RESULTS: In all patients, endoscopic clips were applied proximal to the lesion without complications, and the applied clips were confirmed by plain abdominal radiography. The clips were successfully detected by LUS in all patients. In the resected specimen, the serosal surface, marked with dye, was always just above the clips in the anterior wall or on the anterior wall opposite the clips applied in the posterior wall. The mean detection time was 4.7 min (range, 2-8). With this procedure, two patients underwent total gastrectomy and 15 patients underwent distal subtotal gastrectomy with gastroduodenostomy or gastrojejunostomy. Histological examination confirmed that the resection margins were tumor free in all patients. There was no operative morbidity related to the LUS procedure. CONCLUSIONS: Using LUS to detect endoscopic clips is an easy, safe, and accurate method to localize EGC lesions in laparoscopic-assisted gastrectomy.

Adult↗
PubMed2002

Reduced thiamine (vitamin B1) levels following gastrectomy for gastric cancer.

BACKGROUND: Vitamin B1 deficiency is well known as a possible complication following gastric restrictive surgery for morbid obesity; however, reduced vitamin B1 levels in patients who have undergone gastrectomy for gastric cancer have not been discussed previously. METHODS: Serum vitamin B1 levels were determined after the return to normal daily activity in 54 patients with distal gastrectomy for gastric cancer, 32 patients with total gastrectomy for gastric cancer, and 30 patients with radical surgery for colorectal cancer. Changes from serum vitamin B1 levels before operation to those after return to normal daily activity, without nutritional support, were investigated in 25 patients with gastrectomy for gastric cancer and 26 patients with radical surgery for colorectal cancer. RESULTS: Decreased serum vitamin B1 levels, below the normal range, were recognized in 7 of the 54 distally gastrectomized patients and in 5 of the 32 totally gastrectomized patients, whereas no such decrease was recognized in any patient after colorectal surgery. Decreased serum vitamin B1 level was recognized within 6 months after the operation in 6 of the 7 distally gastrectomized patients showing a decreased vitamin B1 level and in 3 of the 5 totally gastrectomized patients showing a decreased vitamin B1 level. Postoperative serum vitamin B1 levels were significantly lower than those before operation in patients with gastrectomies, whereas there was no significant difference in serum vitamin B1 levels before and after the surgeries in patients with surgery for colorectal cancer. CONCLUSION: Vitamin B1 levels may be reduced in gastrectomized patients, especially within 6 months after operation, even after their return to normal daily activity without nutritional support.

Aged↗
PubMed1989

Electrical activity recorded from abdominal surface after gastrectomy or colectomy in humans.

The visceral electrical activity recorded from the abdominal surface was studied before and after either total gastrectomy or colectomy. The patterns obtained from fast Fourier transform analysis demonstrated the disappearance of the power peak of approximately 3 cpm after gastrectomy, whereas colectomy did not result in the disappearance of the power peak of approximately 3 and 8-12 cpm. Only the frequencies of approximately 3.5-7.5 cpm were not present after colon surgery. These data demonstrate that the spectral power peaks at frequencies of approximately 3 cpm are entirely related to the stomach because they disappear after gastrectomy; the power peaks between 3.5 and 7.5 cpm are related to the colon because they are present after gastrectomy but not after colectomy; the power peaks between 7.5 and 11 cpm are related to the small intestine because they are present after either gastrectomy or colectomy. The authors conclude that the electrical activity recorded from the abdominal surface and analyzed by fast Fourier transform gives reliable information concerning the electrical activity of the stomach and small intestine, although it is less reliable concerning the electrical activity of the colon.

Abdomen↗
PubMed1989

Exocrine pancreatic function after gastrectomy. Specificity of indirect tests.

We compared intraindividually the specificity of indirect pancreatic function tests before and after total (n = 4; Roux-en-Y) or subtotal (n = 6; Billroth II) gastrectomy. Before gastrectomy only 1 patient showed a falsely pathological result with the pancreolauryl test (90% specificity), while the results of all the other tests were correctly normal (100% specificity using the usual cutoff limits). After gastrectomy the respective specificities were as follows: pancreolauryl test 10%, bentiromide test 70%, fecal chymotrypsin 70%, and plasma amino acid consumption test 100%. There was no obvious difference in the reduction of specificity between subtotal and total gastrectomy. The respective preoperative to postoperative changes in the median test data were as follows: plasma amino acid consumption test +21%, bentiromide test -12%, fecal chymotrypsin -51%, and pancreolauryl test -53%. It is concluded that after gastrectomy only the plasma amino acid consumption test is unaffected by postoperative anatomic alterations.

Adult↗
PubMed1995

Somatostatin binding capacity, guanylate cyclase and tyrosine phosphatase activities during pancreatic proliferation in the rat induced by gastrectomy.

Gastrectomy increased pancreatic growth and this effect was associated with an increase in the number of somatostatin-14 (SS) receptors (146% of control) without altering their affinity. SS increased guanylate cyclase activity twofold in pancreatic acinar membranes from gastrectomized rats. The gastrectomy decreased pancreatic SS-like immunoreactivity (SS-LI) content (55% of control levels) and tyrosine phosphatase activity (74% of control levels). Administration of proglumide (20 mg/kg, IP), a gastrin/cholecystokinin (CCK) receptor antagonist, suppressed the inhibitory effect of gastrectomy on basal tyrosine phosphatase activity and SS-LI content, which returned to control levels. Furthermore, proglumide suppressed the increase of the number of SS receptors and of SS-stimulated guanylate cyclase activity induced by gastrectomy. All this suggests that pancreatic acinar cell growth is associated with upregulation of SS receptors, which could represent a mechanism promoted by the cell to negatively regulate the mitogenic activity of pancreatic growth factors such as CCK. In addition, the results also suggest that the negative regulation of tyrosine phosphatase activity may be important in the events involved in the pancreatic hyperplasia observed after gastrectomy.

Animals↗
PubMedDate not supplied

Gastrectomy enhances vulnerability to the development of alcoholism.

A history of gastrectomy was more frequently encountered in Japanese male alcoholics (9.7%, 47/486) than in male employee populations of two large companies (0.8%, 36/4,381, p < 0.001, and 0.6%, 6/950, p < 0.001). Gastrectomized men are known to achieve a higher blood ethanol level after the ingestion of the equal amount of ethanol than nongastrectomized men. To examine whether or not gastrectomy was responsible for the subsequent development of alcohol dependence, 47 gastrectomized alcoholics were compared with 47 age-matched nongastrectomized alcoholics. The mean lifetime duration of heavy drinking (> 120 g ethanol/day) was shorter in the former than in the latter (11 +/- 10 years vs. 16 +/- 9, p < 0.05), and the mean lifetime cumulative ethanol consumption level also smaller (834 +/- 497 kg vs. 1047 +/- 508, p < 0.05). The majority of gastrectomized patients (30/47) had no history of problem drinking before gastrectomy. The daily consumption was rapidly increased within 5 years after gastrectomy in 18 of 38 habitual drinkers (47%). Seven of the remaining nine nonhabitual drinkers (78%) became habitual drinkers and alcoholics within a short period of time (7 +/- 4 years), though with low lifetime cumulative consumption (< 400 kg). The incidence of disorders of the central and peripheral nervous systems observed did not differ between the two groups, except for frequent alcoholic blackouts reported in the gastrectomized patients. In conclusion, the majority of the gastrectomized patients changed their drinking habits after gastrectomy and developed alcohol dependence. They did not require as much lifetime cumulative ethanol as nongastrectomized patients to become ethanol dependent.

Adult↗
PubMed2004

Increased breath nitrous oxide after ingesting nitrate in patients with atrophic gastritis and partial gastrectomy.

BACKGROUND: Toxic nitrite and N-nitroso compounds due to gastric bacterial growth are often detected in the stomach of patients with atrophic gastritis and partial gastrectomy. The aim of this study is to investigate whether breath N2O, a major metabolite of denitrification, detected after ingestion of nitrate is associated with atrophic gastritis and partial gastrectomy. METHODS: Nine young, 16 normal older, nine atrophic gastritis and six partial gastrectomy subjects ingested 100 g lettuce, equal to 130 mg nitrate, and breath N2O was measured at 15-min intervals for 5 h. N2O was analyzed using an infrared-photoacoustic analyzer, and atrophic gastritis was diagnosed by pepsinogen test. RESULTS: The mean breath N2O concentrations were higher in the following order at all times: partial gastrectomy>atrophic gastritis>normal>young. The maximum N2O concentrations in the patients with partial gastrectomy and atrophic gastritis were 1655 +/- 296 and 1350 +/- 200 (mean +/- S.E.) ppb, respectively, which were higher than that of the normal subjects, 827 +/- 91 ppb (P < 0.05). The maximum N2O concentration in young people was 527 +/- 86 ppb, which was lower than that of the normal older people (P < 0.051). CONCLUSION: These higher N2O concentrations in gastric patients reflect bacterial growth in the stomach due to the reduction of gastric acid.

Adolescent↗
PubMed2005

Treatment of early gastric cancer in the elderly patient: results of EMR and gastrectomy at a national referral center in Japan.

BACKGROUND: The Japanese population is rapidly aging, and the actual number of elderly patients with gastric cancer, including early cancer, has been increasing, even though the standardized incidence of gastric cancer in the population is decreasing. The optimal treatment for these patients remains a challenge to the surgeon. The aim of this retrospective analysis was to describe the results of gastrectomy and EMR for early gastric cancer in elderly patients (80 years of age and over). METHODS: This is a retrospective review of 93 elderly patients who had undergone gastrectomy or EMR at the National Cancer Center Hospital for early gastric cancer. EMR was performed aiming en bloc local resection with a clear curative margin (R0). The clinicopathologic characteristics, comorbidity, postoperative mortality, and outcome were recorded. RESULTS: Gastrectomy was performed in 44 patients (surgery group) and EMR in 49 patients (EMR group). There were significant differences in mean tumor size (p < 0.05), histologic type (p < 0.05), and depth of tumor invasion (p < 0.05) between the two groups. There was no significant difference in comorbidity between the two groups. No operative death was reported in either group. In the EMR group, 7 patients were reported to have recurrence of local disease and two patients died of advanced disease. There were no significant differences in the overall 3-year survival rate or the 5-year survival rate between the surgery group and EMR group (73.5% vs. 82.5% and 55.0% vs. 62.5%, respectively). CONCLUSIONS: EMR (R0) resection was performed safely in the elderly, and the overall results were excellent, the same as the results with gastrectomy. Gastrectomy can still be performed if EMR is unsuccessful.

Aged↗
PubMed2005

Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute's prospective analysis.

BACKGROUND: Laparoscopic surgery for gastrointestinal benign disease has gained worldwide acceptance; totally laparoscopic surgery for malignant diseases remains controversial. The purposes of this study were to examine prospectively our experience with laparoscopic gastric resections, to evaluate the surgical outcomes, and to discuss the role of these procedures in the treatment of benign and malignant diseases of the stomach. To the best of our knowledge, this is the largest prospective study of totally laparoscopic total and partial gastrectomies in Western countries. STUDY DESIGN: Thirty-three patients who underwent totally laparoscopic gastric resection between April 1995 and January 2004 were studied prospectively. Eight patients underwent laparoscopic total gastrectomy and 25 patients had laparoscopic partial gastrectomy. There were 21 women and 12 men with a mean age of 71 +/- 10 years. RESULTS: Twenty-one patients (63.6%) were operated on for malignant diseases and 12 patients (36.4%) had benign lesions. Conversion to laparotomy was not required in any case. Mean operative time was 138 +/- 40 minutes and mean blood loss was 58 +/- 85 mL. There were no major intraoperative complications except for one splenectomy, and there were no perioperative deaths. Two postoperative complications occurred; one patient developed an intraperitoneal abscess with a small duodenal fistula after total gastrectomy and was treated by peritoneal lavage and drain placement. The other patient developed delayed gastric emptying after subtotal gastrectomy and was managed conservatively. Mean ambulation time and mean hospital stay were 2.3 +/- 0.7 days and 14.6 +/- 5 days, respectively. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 22 +/- 12 (range 10 to 53). CONCLUSIONS: This prospective trial demonstrated that totally laparoscopic total and partial gastric resections had good results and were feasible and safe procedures. In addition, we concluded that the totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles.

Aged↗
PubMed2006

Prophylactic gastrectomy for hereditary diffuse gastric cancer syndrome.

BACKGROUND: Germline mutations in the E-cadherin gene, CDH1, were recently identified in families with hereditary diffuse gastric cancer. The efficacy of endoscopic surveillance by current methods is largely ineffective because most tumors spread diffusely. There has been little evidence that prophylactic gastrectomy should be performed in patients with the genetic mutation, and few data are available on the outcomes of operations in patients with the CDH1 mutation undergoing prophylactic gastrectomy. We report the outcomes of patients with the CDH1 mutation who have undergone prophylactic gastrectomy in the year 2003 to 2004. STUDY DESIGN: After genetic counseling and informed consent, two patients underwent total gastrectomy with Roux-en-Y reconstruction. Demographic information, pedigree analysis, preoperative screening results, operative course, and postoperative data, including complications, were collected and reviewed for each patient. RESULTS: Pathologic examination of the stomach revealed no evidence of in situ or invasive carcinoma. There were no operative complications. Both patients reported diarrhea and moderate weight loss. There were no other postoperative complications. CONCLUSIONS: Prophylactic gastrectomy can be performed safely, without mortality or severe morbidity, in patients with CDH1 mutations, and should be curative in this population of patients.

Adolescent↗
PubMed2005

Postoperative ghrelin levels and delayed recovery from body weight loss after distal or total gastrectomy.

BACKGROUND: Body weight loss is a common but one of the most serious sequelae after gastrectomy. Ghrelin, a novel gastric hormone that up-regulates body weight through appetite control and metabolic reaction, seems to be affected by gastric surgery. PATIENTS AND METHODS: Early postoperative alteration of serum ghrelin was evaluated at days 3 and 7 after gastrectomy for 13 hospital patients. In 64 outpatients who had previously undergone total gastrectomy (TG: 26 patients) or distal gastrectomy (DG: 38 patients) 4.6 months to 136 months (average, 41 months) earlier, the association between their serum ghrelin and leptin levels and postoperative body weight was investigated. RESULTS: Serum ghrelin declined immediately and greatly after TG to 12% of the preoperative level (day 3 and day 7), whereas the decline was less significant after DG at 39% (day 3) and 56% (day 7). In outpatients, serum ghrelin after TG was very low compared with the control (18.6 fmol/mL versus 92.1 fmol/mL, P<0.0001), irrespective of the period after surgery, whereas the level after DG recovered and was equivalent to the control (73.4 fmol/mL, P=0.355). Body weight loss was more apparent in TG patients than in DG patients, showing postoperative reduction of body mass index (DeltaBMI) -3.940 versus -1.949 (P<0.0001). Serum leptin concentration, reflecting the systemic fat volume, significantly correlated with BMI in both TG and DG patients, and tended to be lower in TG patients than in DG patients (800 pg/mL versus 1158 pg/mL, P=0.236). CONCLUSION: Persistent decline of serum ghrelin and body weight was observed commonly after total gastrectomy. Further study is needed as to whether or not ghrelin administration can improve the body weight level for these patients.

Aged↗
PubMedDate not supplied

Ingestion of difructose anhydride III, a non-digestible disaccharide, prevents gastrectomy-induced iron malabsorption and anemia in rats.

OBJECTIVE: Total gastrectomy produces iron malabsorption and anemia, and several non-digestible carbohydrates promote mineral absorption. In this study, we examined the effects of feeding difructose anhydride III (DFAIII), a non-digestible disaccharide, on gastrectomy-induced iron malabsorption and anemia in rats in comparison with those of feeding fructo-oligosaccharides (FOS). METHODS: Sham-operated and totally gastrectomized male Sprague-Dawley rats were fed the control, DFAIII (30 g/kg), or FOS (30 g/kg) diet for 4 wk. Feces and tail blood were collected at 2 and 4 wk to evaluate body iron status and iron absorption. RESULTS: Gastrectomy severely decreased net iron absorption, hemoglobin concentration, and hematocrit in the control dietary group. The decreased absorption in gastrectomized rats was restored to the sham control level by feeding the DFAIII or FOS diet. Iron absorption in sham rats was higher in the FOS and DFAIII groups than in the control group. Hemoglobin concentration and hematocrit in gastrectomized rats fed the DFAIII diet, but not the FOS diet, returned to levels comparable to the effects in sham rats fed the control diet. Feeding DFAIII increased short-chain fatty acid pools and decreased pH of cecal contents. These parameters for cecal fermentation correlated with iron absorption. CONCLUSIONS: DFAIII feeding restores gastrectomy-induced iron malabsorption, resulting in complete prevention of iron-deficiency anemia in rats. Cecal fermentation of DFAIII may contribute to the improvement in these gastrectomy-induced defects. Feeding with low level of FOS did not fully improve postgastrectomy anemia.

Absorption↗
PubMed2001

Usefulness of reconstruction with jejunal pouch in total gastrectomy for gastric cancer in early improvement of nutritional condition.

BACKGROUND: Roux-en-Y reconstruction with a jejunal pouch is a modified standard procedure in total gastrectomy for gastric cancer. The aim of the current study was to evaluate the usefulness of the reconstruction using a jejunal pouch in subsequent improvement of the nutritional condition of patients with gastric cancer after total gastrectomy. METHODS: Sixteen patients with gastric cancer treated by total gastrectomy and reconstruction with simple Roux-en-Y from January 1993 to December 1996 and 14 patients treated by total gastrectomy and reconstruction with Roux-en-Y and jejunal pouch from January 1997 to December 1998 were investigated in regard to postoperative heartburn, changes in the body weight, and prognostic nutritional index. RESULTS: Postoperative heartburn occurred in 1 patient (7.1%) among patients treated with Roux-en-Y and jejunal pouch and 3 (18.8%) among patients treated with simple Roux-en-Y. The body weight ratio at 1 year after operation in patients treated with Roux-en-Y and jejunal pouch (88.2% +/- 4.2%) was significantly higher than that in patients treated with simple Roux-en-Y (80.0% +/- 4.6%; P <0.01). The prognostic nutritional index ratios for patients treated with Roux-en-Y and jejunal pouch at 1 and 3 months after operation were 93.9% +/- 9.1% and 101.7% +/- 11.0%, respectively, and were significantly higher than that in patients treated with simple Roux-en-Y (86.2% +/- 8.8% and 88.1% +/- 8.2%, P <0.05 and P <0.01, respectively). CONCLUSIONS: Reconstruction using a jejunal pouch in total gastrectomy is useful for an early improvement of the nutritional condition of patients with gastric cancer.

Aged↗
PubMed1988

Canine motility and gastric emptying after subtotal gastrectomy.

The aim of the present study was to elucidate factors influencing gastric emptying in dogs after a two-thirds distal gastrectomy with either Roux-Y or Billroth I reconstruction. The effects of a medium-viscosity nutrient meal on gastrointestinal motility and gastric emptying were investigated. Motility was recorded with long-term implanted extraluminal strain gauge force transducers; gastric emptying was measured radiographically. Gastric emptying after Roux-Y gastrectomy was almost linear and not different from that in intact control dogs. In contrast to Roux-Y gastrectomy, emptying after Billroth I gastrectomy was initially accelerated and followed by a slow emptying phase. During the initial period, the segmenting activity of the Roux-Y limb significantly differed from the propulsive contractile pattern of the duodenum after Billroth I reconstruction. Force and frequency of gastrointestinal contractions were equivalent after both reconstruction procedures. Results indicate that after subtotal gastrectomy, the intestinal contractile patterns are important determinants of gastric emptying. They are the main causes for the different emptying patterns of viscous nutrient meals.

Anastomosis, Roux-en-Y↗
PubMed1988

Near-total gastrectomy for gastric cancer.

Fifty-nine consecutive patients (95 percent) with gastric cancer of the distal portion of the stomach were operated on with 95 percent subtotal gastrectomy between 1975 and 1980. The operations were for cure in all cases. Twenty-five patients were alive after 5 years, for a crude 5 year survival rate of 42 percent. The operative mortality rate was 5 percent (three patients). Twenty-four patients (41 percent) had complications, which consisted of postoperative respiratory infection in 11 patients (19 percent), postoperative ileus in 4 patients (7 percent), and subphrenic abscess in 2 patients (3.4 percent). In addition, there was one wound dehiscence and one liver rupture (with fatal outcome), one deep venous thrombosis, one urinary infection, and one wound infection. Only one patient (1.7 percent) had an anastomotic leak at the gastrojejunostomy site. Seven relaparotomies (12 percent) had to be performed for complications. We have concluded that, in patients with distal gastric cancer, 95 percent subtotal gastrectomy can result in a 5 year survival rate that is comparable to that reported in the literature for total gastrectomy, and it has the advantage of a very low rate of anastomotic leakage between the minute gastric remnant and the jejunum. Therefore, 95 percent subtotal gastrectomy is recommended over total gastrectomy in the treatment of distal gastric cancer.

Adenocarcinoma↗
PubMed1995

Effectiveness of extended lymphadenectomy in noncurative gastrectomy.

PURPOSE: We examined the efficacy of extended lymph node dissection for prolonging survival in macroscopically or histologically proven incurable gastric cancer. PATIENTS AND METHODS: We analyzed clinico-pathologic data on 119 patients with serosally invasive gastric cancer who underwent noncurative gastrectomy, with respect to the relation between the extent of lymphadenectomy and survival benefit. RESULTS: The 5-year survival rate was significantly higher among patients treated with extensive lymphadenectomy (R2/3) compared to simple gastrectomy (R1). Extensive lymphadenectomy significantly prolonged survival time even after noncurative gastrectomy in cases where there was no evidence of hepatic metastasis, peritoneal seeding, or extensive nodal metastasis beyond the tertiary lymph node, and regardless of the extent of direct invasion to adjacent organs. CONCLUSIONS: Gastrectomy combined with extended lymphadenectomy and/or resection of adjacent organs is recommended for gastric cancer patients without distant metastasis, even when the operation is histologically noncurative. Gastrectomy and perioperative intensive chemotherapy are called for when patients have distant metastasis.

Adenocarcinoma↗