The authors present a case study of 100 patients who underwent total gastrectomy for adenocarcinoma out of a total of 390 patients submitted to surgery for gastric cancer between 1970 and March 1993. The majority of the neoplasms were located in the middle third of the stomach with histological characteristics of epithelial type, 11 of which were classified Stage IA, 7 Stage IB, 14 Stage II, 25 stage IIIA, 26 Stage IIIB and 17 at Stage IV. A R2 total gastrectomy which included the distal 2-3 centimeters of the esophagus and the proximal 2-3 centimeters of the duodenum, combined with omentectomy and level 1 and 2 lymphadenectomy, was always performed. Thirty-four of the operations were extended and splenectomy was performed in 27 of these. Digestive continuity was obtained in 39 cases with an esophago-jejunostomy on a Roux-en-y loop. Recanalization of the duodenum was obtained according to the Moricca technique in 31 cases and according to the Mouchet-Camey technique in 21 cases. Of the remaining 9, 5 underwent reconstructive surgery as described by Sweet-Allen, 2 according to Nakayama and the remaining 2 a direct esophago-duodenostomy. The majority of the cases received TPN as of the II postoperative day that was maintained for the following 8 days. Post-operative mortality, reported during the initial 30 days was 7%, overall morbidity 15%. A detailed protocol of clinical and diagnostic tests was established for follow up studies conducted on a 4 month basis. Follow up results showed 39 patients with distant metastases, while 19 had locoregional recurrences at different intervals from surgery. Three patients underwent a II operation for recurrence and 5 for other reasons. The nutritional consequences of total gastrectomy were evaluated by the performance status and by the investigation of a possible malabsorption syndrome (measurement of carotenemia and steatorrhea) and of a possible biliopancreatic esophageal reflux (hepatobiliary scintigram). The authors conclude that total gastrectomy is never to be executed as the surgical option of primary choice and agree upon its following indications: Stage II (or greater) neoplasms of the distal third of the stomach, Stage IB (or greater) of the middle third and at any Stage of the proximal third. With regard to the reconstructive technique, recanalization of the duodenum is preferred in cases that inspire a good life expectancy.
|Translated title of the contribution||Adenocarcinoma of the stomach: Hundred consecutive total gastrectomies. Surgical results and 5 year follow-up|
|Number of pages||8|
|Publication status||Published - 1994|
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