A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer - PubMed (original) (raw)
Clinical Trial
A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer
C S Robertson et al. Ann Surg. 1994 Aug.
Abstract
Objective: The authors determined if more radical surgery with extended lymphadenectomy improves the results of gastrectomy in patients with adenocarcinoma of the gastric antrum.
Summary background data: The overall survival in patients with gastric cancer is disappointing. Improved survival has been reported by Japanese authors. Whether this is because of a higher number of early gastric cancers in the Japanese series, different biologic behavior in Asians, or the adoption of radical surgery with lymphadenectomy remains unclear.
Methods: R1 subtotal gastrectomy with omentectomy and R3 total gastrectomy (omentectomy, splenectomy, distal pancreatectomy, lymphatic clearance of the celiac axis, and skeletonization of vessels in the porta hepatis) were evaluated in a prospective, randomized comparison.
Results: Fifty-five patients were randomized--25 to the R1 group and 30 to the R3 group. The two groups were comparable for age, sex, tumor size, TNM stage, and length of follow-up. The R3 group had a longer operating time (140 vs. 260 min; p < 0.05), a greater transfusion requirement (0 vs. 2 units, p < 0.05) and a longer hospital stay (8 vs. 16 days; p < 0.05) (medians; Mann-Whitney U test). The only postoperative death was in the R3 group and was caused by intra-abdominal sepsis. Fourteen patients in the R3 group developed left subphrenic abscesses. There were no major complications in the R1 group. Overall survival was significantly better in the R1 group (median survival estimated by Kaplan-Meier method, 1511 vs. 922 days, p < 0.05, log-rank test).
Conclusions: R3 total gastrectomy can be performed with a low mortality, but it has a high morbidity because of intra-abdominal sepsis. The data do not support the routine use of R3 total gastrectomy for treatment of patients with antral cancer.
Comment in
- The operative mortality rate in the R3 total gastrectomy group.
Noguchi M. Noguchi M. Ann Surg. 1995 Nov;222(5):688-9. Ann Surg. 1995. PMID: 7487218 Free PMC article. No abstract available. - A prospective randomized trial comparing R1 subtotal gastrectomy with R3 total gastrectomy for antral cancer.
Roukos D, Marcouizos G, Batsis C, Kappas A, Encke A. Roukos D, et al. Ann Surg. 1996 Jul;224(1):108-9. doi: 10.1097/00000658-199607000-00022. Ann Surg. 1996. PMID: 8678611 Free PMC article. Clinical Trial. No abstract available.
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