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PubMed1991

Impact of splenectomy on survival following gastrectomy for adenocarcinoma.

From 1972 to 1985, 161 palliative and 99 curative gastrectomies were performed, including splenectomy (SPL), in 49 and 42 patients, respectively. The relative contribution of tumor histology and location of primary tumor within the stomach to median survival times in months (MST) was examined by chi-square analysis for patients who had SPL and those who did not. MST for the 40 patients treated by curative gastrectomy and SPL was 33 months compared with 43.5 months in the 56 patients treated by curative gastrectomy without SPL (P = .24). Three postoperative deaths were excluded from this analysis. Neither tumor location nor the histological type had a statistically significant impact on MST within these two groups. SPL was not found to have statistically significant impact on survival following curative gastrectomy. In 46 patients treated by palliative gastrectomy with SPL the MST was 10.5 months compared with 15.5 months in 110 patients who were treated by palliative gastrectomy without SPL (P = .007). Five postoperative deaths and three patients in which primary tumor location could not be accurately determined were excluded from this analysis. The MST of 23 patients treated by SPL who had poor or undifferentiated histology was 8 months, compared with 15 months in 73 patients with similar histology not treated by SPL (P = .02). There was no statistically significant difference in MST between palliative gastrectomy patients who had well or moderately differentiated histology treated with (n = 23) and without (n = 37) SPL (P = .11). The impact of SPL on MST following palliative gastrectomy was not significantly influenced by tumor location in the stomach.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1987

Release of cholecystokinin and gallbladder contraction before and after gastrectomy.

The contraction of the gallbladder by ultrasonography and release of cholecystokinin (CCK) by specific radioimmunoassay in response to the ingestion of oral fatty meal before and 1 month after gastrectomy in five patients with early gastric cancer was studied. Before gastrectomy, basal concentrations of CCK (13.4 +/- 2.3 pmol/L) rose significantly to a maximum of 23.3 +/- 3.6 pmol/L at 20 minutes after ingestion of oral fatty meal, and remained significantly elevated during the study. Gallbladder contraction began as CCK concentrations rose, demonstrating significant correlation with plasma CCK. One month after gastrectomy, CCK showed a rapid and greater response to the ingestion of fatty meal, attaining a maximum of 53.7 +/- 7.3 pmol/L at 10 minutes, then gradually falling to basal level. The maximal contraction of the gallbladder after gastrectomy was almost the same as before gastrectomy (62.7 +/- 4.0% of original area), showing a significant correlation with plasma CCK, but refilling of the gallbladder was induced earlier with corresponding reduction of plasma CCK. Simultaneous measurement of plasma concentrations of pancreatic polypeptide revealed a fairly similar response to plasma CCK before and after gastrectomy. The release of CCK is the chief mechanism by which the ingestion of a fatty meal causes contraction of the gallbladder even after gastrectomy as well as before gastrectomy.

Aged↗
PubMed1994

[A comparative study of therapeutic effects of total versus proximal subtotal gastrectomy in adenocarcinoma of the gastric cardia].

485 patients with adenocarcinoma of the gastric cardia operated in our hospital. 283 cases were treated with total gastrectomy, and 202 cases were treated with proximal subtotal gastrectomy. The age, sex, clinical stage, size of tumour, radicality of surgical resection, lymph node involvement, tumour depth penetration and histological type had no significant difference in the two groups. Analysis of survival rates failed to demonstrate any significant difference between the two types of surgical operation for TNM stage I and II. Total gastrectomy resulted in significantly higher survival rate than proximal subtotal gastrectomy for stage III. The 3- and 5-year survival rate of TNM stage III patients increased by 14.6% and 15.1%, respectively (P < 0.05). Extended total gastrectomy was usually applied for stage IV patients without distant metastasis. If the neoplasm had spread beyond the confines of extended total gastrectomy, in order to eliminate obstruction or bleeding, palliative proximal subtotal gastrectomy or total gastrectomy should be considered.

Adenocarcinoma↗
PubMed1994

A comparative study of gastrectomy without vagotomy with either Roux-en-Y or Billroth II anastomosis in peptic ulcer.

Since recent small uncontrolled studies have suggested that surgery for peptic ulcer comprising partial gastrectomy with Roux-en-Y anastomosis without vagotomy effectively prevents postoperative enterogastric reflux without increasing ulcer recurrence rate, we have compared mortality, ulcer recurrence rate, and complaints in ulcer patients who had undergone partial gastrectomy with either Roux-en-Y (n = 47) or Billroth II anastomosis (n = 47). The groups were comparable with regard to age, sex, ulcer localisation, indication for surgery and number of emergency procedures. During postoperative follow-up, seven patients with Roux-en-Y have died, compared with nine patients with Billroth II gastrectomy. In two of the seven patients who died after Roux-en-Y gastrectomy, but in none of the nine who died after Billroth II resection, death was unequivocally related to postoperative ulcer recurrences. At 1, 2, 3 and 4 years postoperatively, 90 vs. 100% (not significant), 78 vs. 98% (p < 0.01), 72 vs. 95% (p < 0.01) and 72 vs. 95% (p < 0.01) of the patients were in remission after Roux-en-Y and Billroth II gastrectomy, respectively. All ulcers were localized at or just distal to the anastomosis, and were diagnosed within the first 3 postoperative years. We conclude that in peptic ulcer patients the ulcer recurrence rate after Roux-en-Y gastrectomy without vagotomy is considerably higher than after Billroth II resection. Thus, gastrectomy with Roux-en-Y anastomosis without vagotomy cannot be recommended as the primary procedure in patients undergoing partial gastrectomy for peptic ulcer disease.

Adolescent↗
PubMed1998

[Assessment of function preserving gastrectomy for early gastric cancer].

To assess function preserving gastrectomy for early gastric cancer, the effectiveness of a reduction of the extent of gastrectomy, preservation of pylorus, and preservation of vagus nerve was evaluated. Postoperative physical results after pylorus-preserving gastrectomy with preservation of vagus nerve (group I, 32 cases), 2/3 distal gastrectomy with preservation of vagus nerve (group II, 12 cases), 2/3 distal gastrectomy without preservation of vagus nerve (group III, 21 cases) and 4/5 distal gastrectomy without preservation of vagus nerve (group IV, 81 cases), were investigated. Postoperative/ preoperative body-weight ratio in groups I (96.6%) and II (97.4%) was significantly higher than in groups III (92.2%) or IV (89.5%). The patients in groups I and II had fewer abdominal symptoms than in group IV. The gastric emptying pattern of patients in group I was slower than in the other groups. Contraction of the gallbladder in groups I and II was better than in group IV. The serum concentration of cholecystokinin after meals was low in group I, but increased rapidly in the other, groups. Reducing the extent of gastrectomy, preserving the pylorus, and preserving the vagus nerve, resulted in preservation of physical status after gastrectomy.

Body Weight↗
PubMed1996

Gastrectomy for Complications of Bariatric Procedures.

BACKGROUND: Major complications of modern bariatric operations are infrequent but can be quite disabling to the patient and pose therapeutic challenges to the surgeon. We present our experience with five patients who underwent gastrectomy for complications following gastric reduction procedures. PATIENTS AND METHODS: Between 1991 and 1995, four women and one man, average age 46.8 years (34-66), underwent total gastrectomy and Roux-en-Y end-to-side esophagojejunostomy (4), or near-total gastrectomy with esophagogastrostomy (1). The decision to perform total gastrectomy was based on the poor quality of the remaining gastric pouch and the surgeon's judgement. Preoperative diagnoses included gastric outlet obstruction secondary to anastomotic ulcer or stricture, gastroesophageal reflux with esophagitis, chronic gastrocutaneous fistula, and iatrogenic linitis secondary to gastric wrap with mesh. Preoperatively, the patients complained of intolerable nausea, vomiting, abdominal pain, and dysphagia. RESULTS: in the five patients who underwent total or near-total gastrectomy, there was no operative mortality or morbidity; however, one patient (near-total gastrectomy) has required a second operation for pyloroplasty. Although one patient was lost to follow-up 6 months after surgery, the average follow-up for the remaining four patients is 2 years. These four patients were interviewed and all report complete satisfaction with their surgery and much improvement in their symptoms. Presently, they consume an average of three meals per day (range 2-6), with each meal measuring about 2 cups in size. All report the sensation of satiety after meals. All patients receive supplemental iron, B12, and multivitamins. From a nutritional standpoint, there has not been a significant change in the levels of albumin, total protein, hematocrit, weight and BMI since total gastrectomy. CONCLUSIONS: In our experience, total gastrectomy with Roux-en-Y end-to-side esophagojejunostomy is an appropriate therapy with low morbidity and mortality in highly selected patients with complications resulting from gastric reduction procedures.

Journal Article↗
PubMed2006

Clinical outcome of high segmental gastrectomy for early gastric cancer in the upper third of the stomach.

BACKGROUND: Reflux oesophagitis is commonly encountered in the surgical treatment of cancer of the upper third of the stomach. The aim of this study was to describe a novel surgical technique and evaluate the clinical outcome of high segmental gastrectomy for early-stage proximal gastric cancer. METHODS: Thirty consecutive patients with early gastric cancer located in the upper third of the stomach were included, of whom 12 underwent high segmental gastrectomy and 18 underwent proximal gastrectomy with jejunal interposition. The incidence of reflux oesophagitis and nutritional parameters were compared between the two groups at 1 year after operation. RESULTS: One patient had mild reflux symptoms and two had endoscopic evidence of oesophagitis 1 year after high segmental gastrectomy. Half of the patients who had proximal gastrectomy had reflux symptoms of varying severity and 14 had endoscopic evidence of oesophageal changes at 1 year after surgery. There were significant differences between groups in the incidence of reflux symptoms (P = 0.016) and endoscopically detected gastro-oesophagitis (P < 0.001). There were no adverse events in either group, and the survival rate after high segmental gastrectomy appeared favourable. CONCLUSION: Selected patients with early-stage proximal gastric cancer benefit from high segmental gastrectomy in terms of reduced reflex oesophagitis, without jeopardizing curability.

Aged↗
PubMed2005

Clinical outcome of esophageal cancer patients with history of gastrectomy.

BACKGROUND: Surgery for thoracic esophageal cancer after gastrectomy involves a complicated reconstruction procedure. A surgeon's hesitation is further increased because the clinical outcome of surgical treatment of these patients has not been elucidated. OBJECTIVES: Among 948 thoracic esophageal cancer patients who underwent curative operation, 72 (7.6%) had a history of gastrectomy. Their clinico-pathological features and survival (follow-up average 881 days) were compared with those without gastrectomy. RESULTS: Esophagectomy for patients after gastrectomy was performed via right thoracotomy (66), left thoracotomy (4), and transhiatal resection (2), and reconstruction was done using the right-side colon (57) or jejunum (15). Compared to non-gastrectomized patients, gastrectomized patients were exposed to longer operation time (523 min vs. 460 min), but no significant difference was observed in operative mortality (4.2% vs. 2.5%) or blood loss (1,189 ml vs. 990 ml). Pathological examination showed no significant difference in depth of tumor invasion, lymph node metastasis, and TNM staging between gastrectomized and non-gastrectomized patients, while tumors were located at lower position in the gastrectomized patients (P = 0.046). The overall and cause-specific 5-year survival rates were 56% and 65% for gastrectomized esophageal cancer patients, which were significantly better than for non-gastrectomized patients (36% and 44%, P = 0.0235 and 0.024, respectively). Multivariate analysis showed gastrectomy as a marginally independent factor for a favorable prognosis (hazard ratio 1.832, P = 0.0324). With respect to tumor recurrence, hematogenic metastasis tended to be less frequent in gastrectomized patients than in non-gastrectomized patients. In gastrectomized patients, neither disease (peptic ulcer or gastric cancer) nor reconstruction (Billroth-I, Billroth-II, and Roux-Y) for gastrectomy affected the clinicopathological findings or post-operable survival. CONCLUSIONS: Surgical treatment of esophageal cancer patients after gastrectomy was complicated but tolerable, and should be considered as a reliable therapeutic modality because of favorable patient prognosis.

Adult↗
PubMedDate not supplied

Reconstruction after gastrectomy and quality of life.

To evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n = 59) or simple esophagojejunostomy (n = 24) and distal subtotal gastrectomy (n = 21). No significant differences were found between total gastrectomy with pouch reconstruction and distal gastric resection with respect to dumping or heartburn, whereas patients with total gastrectomy and restoration with esophagojejunostomy suffered from both. The latter group of patients also had reduced nutritional status. Although there is a lack of a proper definition of quality of life, all instruments applied to its measurement indicated improved results for patients with pouch reconstruction and those after distal gastrectomy, but we could not state any significant differences. We conclude that in terms of postoperative functional results as well as quality of distal gastric resection has no advantage over total gastrectomy with pouch reconstruction; hence a reduction of surgical radicality in an attempt to improve postoperative results is not justified. Pouch reconstruction should be considered the treatment of choice for reconstruction after total gastrectomy.

Adult↗
PubMed1995

Risk of gallstones following gastrectomy in Japanese men.

The risk of gallstones developing after gastrectomy in middle-aged Japanese men was investigated in a study of 2,738 men aged between 48 and 56 years who underwent both gallbladder ultrasonography (US) and a barium study of the upper digestive tract. It was revealed that 61 men had gallstones, 37 had had their gallbladder removed previously, and 55 had a history of gastrectomy. The prevalence of gallstones was 3.5 times higher in the men who had previously undergone gastrectomy (7.7%) than in those who had not (2.2%) (P = 0.03). Moreover, gallstones tended to be more prevalent in those who had undergone Billroth II gastrectomy (12.5%) compared with those who had undergone Billroth I gastrectomy (5.6%); however, the difference was not significant. These results indicate that gastrectomy using either Billroth I or Billroth II reconstruction predisposes to gallstone formation. Nevertheless, it was estimated that prior gastrectomy was responsible for no more than 5% of gallstones in the study population.

Barium Sulfate↗
PubMed1996

Chronological changes in bone mineral content following gastrectomy.

Recent advances in the modalities of quantitatively assessing bone mineral content have resulted in an increasing awareness of metabolic bone disease as a late complication following gastrectomy. In this study, 98 postgastrectomy patients were examined by quantitative computed tomography (QCT). The bone mineral density index (BMDI), defined as 100 x (measured bone mineral density divided by that of age- and sex-matched controls), was used to evaluate the actual effect of gastrectomy on bone disorders. The BMDI values following gastrectomy were 80.4 +/- 27.3, with no significant difference between men and women, or between total and distal gastrectomy. Moreover, no significant differences were observed between the BMDI values within 6 months, being 92.6 +/- 37.3, and those 6 months to 1 year post gastrectomy, being 79.6 +/- 31.2; however, a significant and sharp decrease to 70.5 +/- 36.0 was evident after 1-2 years. The regression coefficient of the BMDI measured within 2 years postoperatively was lower than that measured after 2 years. These findings suggest that the influence of gastrectomy on bone metabolism is induced within 2 years, after which the bone mineral content decreases in accordance with physiological nature. Thus, we conclude that the treatment for bone disease resulting from gastrectomy would only be effective if initiated within a short period after surgery.

Adult↗
PubMed1990

Effect of partial gastrectomy with Billroth II or Roux-en-Y anastomosis on postprandial and cholecystokinin-stimulated gallbladder contraction and secretion of cholecystokinin and pancreatic polypeptide.

This prospective study was undertaken to determine the effect of partial gastrectomy without vagotomy on postprandial gallbladder contraction and secretion of cholecystokinin (CCK) and pancreatic polypeptide (PP) in 22 peptic ulcer patients randomly assigned to either Billroth II (N = 11) or Roux-en-Y (N = 11) anastomosis. The patients were studied within two weeks before surgery and at six months postoperatively. After surgery basal gallbladder volumes were larger than preoperatively (P less than 0.02). Integrated postprandial gallbladder contraction was not significantly affected by gastrectomy, either in the patients with Billroth II anastomosis (2276 +/- 268 vs 1985 +/- 362%/60 min) or in those with Roux-en-Y anastomosis (2045 +/- 327 vs 2445 +/- 352%/60 min) when studied pre- and postoperatively, respectively. Similarly, integrated postprandial plasma CCK secretion was not significantly changed by either Billroth II gastrectomy (200 +/- 31 vs 166 +/- 21 pM/60 min) or Roux-en-Y gastrectomy (146 +/- 26 vs 147 +/- 12 pM/60 min). However, integrated postprandial PP secretion was significantly (P less than 0.05) lower after Billroth II gastrectomy (6.8 +/- 2.4 vs 2.2 +/- 1.0 nM/60 min), while the reduction in plasma PP after Roux-en-Y gastrectomy just failed to reach statistical significance (6.0 +/- 1.5 vs 3.4 +/- 0.9 nM/60 min). Similarly, the PP response, but not the gallbladder response, to an intravenous bolus injection of 1 IDU CCK/kg body weight was significantly decreased after gastrectomy independent of the type of anastomosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Anastomosis, Roux-en-Y↗
PubMed1990

Endoscopic and manometric study of the cardia in post-gastrectomy patients.

This study was undertaken to clarify the incidence of hiatus hernia and the functional changes in the cardia of post-gastrectomy patients. One hundred and four post-gastrectomy patients and 399 non-gastrectomy patients were selected for endoscopic study, and the diagnosis of hiatus hernia was made by observing the shape of the cardia inside the stomach. A manometric study was also done on 12 patients with gastric carcinoma and 14 patients with gallstones. Hiatus hernia was observed in 37.5 per cent of the post-gastrectomy patients, this incidence being significantly higher than the 19.3 per cent of the non-gastrectomy patients (p less than 0.01). In the latter group alone the incidence of hernia steadily increased with advancing age. In the post-gastrectomy patients, reflux esophagitis and heartburn were observed in 20.2 per cent and 27.9 per cent, respectively. These incidences tended to be higher in the patients with hernia but there were no significant differences. The manometric study revealed that lower esophageal sphincter pressure was significantly decreased after gastrectomy, but not after cholecystectomy.

Aged↗
PubMed1997

Changes in body composition after gastrectomy: results of a controlled, prospective clinical trial.

To elucidate mechanisms involved in weight development after gastrectomy we have prospectively determined changes in body composition during the first year after similar operations. A total of 75 patients were enrolled who had a "curative operation" for gastric carcinoma; 42 were randomized to have a total gastrectomy, 23 total gastrectomy with a gastric substitute, and 10 subtotal gastrectomy. All reconstructions were done with a Roux-en-Y loop of the jejunum. Body composition was assessed preoperatively and at 6 and 12 months after gastrectomy by determining total body potassium and total body water. From these estimates, body cell mass, extracellular water, fat-free extracellular solids, and body fat were calculated with knowledge of the actual body weight and length. Triceps skinfold, arm muscle circumference, and grip strength were also measured. Weight loss (10% of preoperative weight) occurred early after the operations, after which body weight stabilized. Body cell mass remained essentially unchanged over the entire study period in contrast to body fat, which decreased by 40% during the first 6 months after gastrectomy. In accordance with the selective loss of body fat, we recorded a significant decrease in triceps skinfold figures and only a minor decrease of arm muscle circumference without obvious deterioration in hand grip strength. Weight loss after gastrectomy seems to be characterized by selective loss of body fat in contrast to other known clinical situations associated with impaired nutritional intake. Our observations form a basis for future clinical research aimed at preventing weight loss after these operations.

Aged↗
PubMed1998

Morphometric analysis of gastrectomy-evoked osteopenia.

Gastrectomy leads to osteopenia in the rat. The present study describes the effects of gastrectomy on bone morphology. Rats were subjected to gastrectomy or sham operation. Four weeks after the operation the rats were killed and both tibiae were removed. Bone morphology of the left tibia was analyzed with quantitative computer tomography, the right tibia with histomorphometry. Bone length, bone mineral content, as well as indices of bone resorption and formation were measured in the metaphysis and the diaphysis. Gastrectomy had no effect on longitudinal bone growth but it led to a low bone mineral content at both sites. Bone resorption was increased by gastrectomy, as shown by an increase in the medullary cavity area in the diaphysis. Gastrectomy also reduced bone formation, as shown by a decreased periosteal circumference and a decrease in the mean periosteal bone apposition in the diaphysis. In conclusion, gastrectomy-evoked osteopenia reflects impaired formation and increased resorption of bone.

Animals↗
PubMed2004

Inflammation of the gastric remnant after gastrectomy: mucosal erythema is associated with bile reflux and inflammatory cellular infiltration is associated with Helicobacter pylori infection.

BACKGROUND: Controversy exists concerning the role of bile reflux and Helicobacter pylori ( H. pylori) infection in the development of inflammation of the gastric remnant after gastrectomy. This study was designed to investigate association of bile reflux and H. pylori infection or both with inflammatory changes in the gastric remnant. METHODS: A questionnaire on GI symptoms was returned by 200 gastrectomy patients, and 24-h bilirubin monitoring in the gastric remnant was performed on 55 patients with Bilitec 2000. Upper GI endoscopy evaluated reflux gastritis in the gastric remnant, and the presence of H. pylori infection and chronic, active inflammatory cellular infiltration in the biopsy specimens were examined microscopically with the updated Sydney system. RESULTS: No difference in the incidence of GI symptoms was observed among individual gastrectomy patients. Bile reflux was lower in patients who had undergone a gastrectomy with jejunal interposition, a pylorus-preserving gastrectomy, and a gastrectomy with Roux-Y anastomosis than those who had undergone a Billroth-II (B-II) anastomosis ( P < 0.05). Endoscopy showed positive correlation between mucosal erythema and bile reflux ( P < 0.001). No correlation was observed between the mucosal erythema and chronic and active inflammatory cellular infiltration. Infection of H. pylori correlated with chronic and active inflammatory cellular infiltration ( P < 0.001). Bile reflux did not correlate with the severity of chronic and active inflammatory cellular infiltration or H. pylori infection. CONCLUSIONS: Bile reflux into the gastric remnant was observed by Bilitec 2000. Mucosal erythema and chronic, active inflammatory cell infiltration in the gastric remnant after gastrectomy may be caused by bile reflux or H. pylori infection, respectively.

Bile Reflux↗
PubMed2001

Multicentric occurrence of esophageal cancer after gastrectomy: a preliminary report.

The effect of gastrectomy on the subsequent development of esophageal cancer was investigated, focusing on its multicentric occurrence. We retrospectively evaluated 28 patients who underwent subtotal esophagectomy for intrathoracic esophageal cancer between 1985 and 1999. They were divided into two groups according to whether or not they had previously undergone a gastrectomy: group 1, comprising 7 patients who had undergone gastrectomy and group 2, comprising 21 patients who had not. Clinical profiles of the patients were obtained from the medical records and the whole resected esophagus was histopathologically examined. The interval between gastrectomy and esophagectomy in group 1 was significantly shorter in the patients who had undergone gastrectomy for gastric cancer than in those who had undergone gastrectomy for a peptic ulcer, and also in the patients for whom anastomosis had been performed by Billroth I compared with Billroth II. The patients in group 1 were significantly younger than those in group 2. The multiple occurrence of esophageal cancer was found in 4 of 5 patients (80%) in group 1, and in 2 of 18 patients (11%) in group 2, with significantly higher frequency being seen in group 1. More than two coexisting cancer lesions apart from the primary tumor were detected in all four patients. Histological examination of all the coexisting cancer lesions showed well-differentiated squamous cell carcinoma confined within the superficial mucosal layer. No significant differences were noted in the location of the coexisting lesions between the oral and anal side of the primary tumors. Squamous dysplasia was randomly observed, especially around the cancer lesions. These findings suggest that gastrectomy precipitated subsequent chronic gastroesophageal reflux which in turn induced the development of squamous dysplasia and carcinoma at multiple locations in the esophagus.

Aged↗
PubMed2004

Complications of gastrectomy with lymphadenectomy in gastric cancer.

BACKGROUND: Currently, gastrectomy and extended lymphadenectomy (LN) is the treatment of choice for gastric cancer. Although a survival rate benefit of D2 LN compared to D1 LN has been shown, the D2 LN procedure is not fully employed, due to possible higher morbidity and mortality rates. These higher rates are being questioned in more recent series, in which D1 and D2 LN complication rates have been similar. The aim of this study was to analyze the immediate postoperative complications of patients submitted to total or subtotal gastrectomy with D1 or D2 LN (according to the Japanese guidelines for gastric cancer) at the Gastrointestinal Surgery Division of the Medical School of São Paulo University, between January 2001 and April 2003. METHODS: One hundred consecutive patients were studied; 61 were men and 39, women. Total gastrectomy was performed in 52 patients (13 with D1 LN and 39 with D2 LN), and subtotal gastrectomy was performed in 48 (11 with D1 LN and 37 with D2 LN). Total or subtotal gastrectomy with D1 or D2 LN was performed according to the tumor extent and histological classification (Lauren's diffuse or intestinal type), considering the patient's general condition and the gastric cancer stage. Roux-en-Y reconstruction was performed in almost all patients. RESULTS: No difference was observed regarding complications and mortality related to the extent of the gastrectomy. Although morbidity was higher in the D1 group, no significant difference was observed. Mortality was higher in the D1 group, and this was probably related to their poor surgical condition and more advanced tumors. CONCLUSION: According to these results, it appears that total or subtotal gastrectomy with D2 LN in gastric cancer treatment, performed according to the Japanese guidelines, can be considered a safe procedure, with acceptable morbidity and mortality, when performed by a trained surgical team.

Adenocarcinoma↗