The role of extended total gastrectomy in advanced gastric cancer.

BACKGROUND/AIMS: Extended total gastrectomy represents, in our experience, 52 out of 443 (11.7%) surgical resections for gastric cancer (1976-1998, 269 total gastrectomies). METHODOLOGY: Enlarged resections were performed on left liver lobe (5 cases), transverse colon (8 cases), pancreas body-tail (35 cases), mesocolon (4 cases), diaphragm (6 cases), jejunum (1 case), and adrenal gland (1 case). RESULTS: Morbidity rate was 18 out of 52 cases (34.60%); 1 esophagus-jejunum anastomosis leakage, 6 cases of pneumonia, 1 pancreatic fistula, 1 p.o. pancreatitis, 3 subphrenic abscesses, 4 cardiocirculatory complications, successfully resolved with conservative therapy. There was one case of postoperative death (1.9% due to cardiac failure). There was a 5-year survival rate for 36.5% of the patients, with follow-ups from 6 months to 11 years. The authors, based on their data, international literature (Roder 1993, Cordiano 1996, Shchepotin 1998) and taking into account mortality and morbidity rates estimate a 5-year survival rate in 30-52% of the cases. CONCLUSIONS: In conclusion, we believe that major surgical procedures for gastric cancer are indicated for every case of suspected neoplastic infiltration of contiguous organs.

Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study.

BACKGROUND/AIMS: The aim of this study was to evaluate functional results after Billroth I, Billroth II and Roux-en-Y reconstruction in subtotal gastrectomy. METHODOLOGY: Forty-five patients were randomized between 1990 and 1995 and stratified in 3 different groups: 15 BI, 15 BII and 15 Roux. They were investigated by esophagogastroduodenoscopy with multiple biopsies and upper gastrointestinal scintiscanning, to evaluate gastroesophageal reflux and dynamics of gastric emptying. They also answered a questionnaire: Gastrointestinal Quality of Life. Index. RESULTS: A reflux esophagitis was found in 5 BI, in 7 BII and in 2 Roux (p < 0.001). No gastric lesions were found in 6 BI, in 5 BII and in 12 Roux, (BI vs. Y, p < 0.05; BII vs. Y, p < 0.001). Chronic superficial gastritis was present in 9 BI, in 4 BII and in 3 Roux (BI vs. Y, p < 0.05). Dynamic scintiscan demonstrated the presence of gastroesophageal reflux in 5 BI and gastric emptying was fast (37' < T 1/2 < 86'), but incomplete (60' residual activity: 49-62%). Gastroesophageal reflux was evident in 7 BII with slow (28' < T 1/2 < 143') and incomplete (60' residual activity: 48-72%) gastric emptying. Gastroesophageal reflux was detected in 2 Roux and radioactive bolus progression in the Roux limb was fast (24' < T 1/2 < 53') and complete (60' residual activity: 42-52%) (BI vs. Y; BII vs. Y, p < 0.001). There was no statistical significance between Gastrointestinal Quality of Life Index score in the 3 groups. CONCLUSIONS: The Authors affirm that Roux-en-Y is the technique of choice in subtotal gastrectomy, if compared with BI and BII.