Subtotal Versus Total Gastrectomy for Gastric Cancer:... : Annals of Surgery (original) (raw)

ORIGINAL ARTICLES

Five-Year Survival Rates in a Multicenter Randomized Italian Trial

Bozzetti, Federico MD*; Marubini, Ettore PhD*; Bonfanti, Giuliano MD*; Miceli, Rosalba PhD*; Piano, Chiara*; Gennari, Leandro MD* the Italian Gastrointestinal Tumor Study Group

From the *Istituto Nazionale per lo Studio e la Cura dei Tumori, and the †Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan, Italy

Correspondence: Federico Bozzetti, MD, Istituto Nazionale Tumori, Via G. Venezian 1, 20133 Milan, Italy.

Accepted for publication April 6, 1999.

Abstract

Objective

To evaluate the impact of subtotal (SG) versus total (TG) gastrectomy on the oncologic outcome of patients with cancer of the distal stomach from 28 Italian institutions.

Summary Background Data

There is controversy over whether SG and TG have a different impact on the 5-year survival probability of patients with cancer of the distal half of the stomach.

Methods

The present analysis involved 618 patients randomized during surgery to SG (315) or TG (303), provided there was at least 6 cm from the proximal edge of the tumor to the cardia, there was no intraperitoneal or distant spread, and it was possible to remove the tumor entirely. Both surgical treatments included regional lymphadenectomy.

Results

Four patients died after SG and seven after TG. Median follow-up was 72 months after SG (range 2 to 125) and 75 months after TG (range 7 to 113). Five-year survival probability as computed by the Kaplan-Meier method was 65.3% for SG and 62.4% for TG. The test of equivalence led to the conclusion that the two procedures may be considered equivalent in terms of 5-year survival probability. The analysis of survival using a multivariate Cox regression model showed a statistically significant impact on survival of tumor site, tumor spread within the gastric wall, extent of resection to the spleen plus or minus neighboring organs or structures, and relative frequency of metastasis in resected lymph nodes.

Conclusions

Both procedures have a similar survival probability. The authors believe that SG, which has been reported to be associated with a better nutritional status and quality of life, should be the procedure of choice, provided that the proximal margin of the resection falls in healthy tissue.