Subtotal gastrectomy or 'en principle' total gastrectomy in cancer of the lower half of the stomach

Background: There is still a matter of controversy whether a subtotal gastrectomy has the same therapeutic potential as a total gastrectomy in distal gastric cancer. Whether all or a subgroup of patients can benefit from total gastrectomy can be answered only by a randomized trial. Method: We therefore assembled a prospective randomized multi-institutional trial which has so far randomized 400 patients for total or subtotal gastrectomy and second level lymphadenectomy. Material: Patients with gastric carcinoma of the lower half of the stomach are eligible unless one of the following conditions exists: Age over 75 years, previous malignant neoplasia except skin cancer, previous gastric resection, high surgical risk, tumor located at less than six centimeters from cardia, tumors not radically resectable. Results: The accrual of patients is still in progress. The available results concern the mortality rate that is higher after total gastrectomy but not statistically different from subtotal resection.