The authors present a case study of 100 patients who underwent total gastrectomy out of a total of 376 patients submitted to surgery for gastric cancer between 1970 and 1992. The majority of the neoplasms were located in the middle third of the stomach with histological characteristics of an epithelial type in 92% of the cases, 8 of which were classified Stage IA, 6 Stage IB, 14 Stage II, 24 Stage IIIA, 25 Stage IIIB, and 15 at Stage IV. An 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 37 cases with an esophago-jejunostomy on a Roux-en-Y loop. Recanalization of the duodenum was accomplished in accordance with the Moricca technique in 32 cases and the Mouchet-Camey technique in 22 cases. Of the remaining 9, 5 underwent reconstructive surgery as described by Sweet-Allen, 2 as described by Nakayama, and the remaining 2 direct esophago-duodenostomy. The majority of the cases received total parenteral nutrition on the second postoperative day and this was maintained for the following eight days. Post-operative mortality, reported during the initial 30 days was 7%, overall morbidity 17%. A detailed protocol of clinical and diagnostic tests was established for follow-up studies conducted on a 4-month basis. Follow-up results showed 37 patients with distant metastases, while 18 had locoregional recurrences at different intervals after surgery. Three patients underwent a second operation for recurrence and 8 for other reasons. The nutritional consequences of total gastrectomy were evaluated by the performance status and by the investigation of a possible maladsorption 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 used as the surgical option of first choice. The authors agree on the following indications: Stage II (or higher) neoplasms of the distal third of the stomach, Stage IB (or higher) of the middle third, and any Stage of the proximal third. With regard to the reconstructive technique, recanalization of the duodenum is preferred in cases with a good life expectancy.
|Number of pages||8|
|Publication status||Published - 1994|
- Gastric cancer
ASJC Scopus subject areas