Correspondence |

Total Gastrectomy

M. Badruddoja, MD, FRCS, FRACS
Arch Surg. 2009;144(3):289-292. doi:10.1001/archsurg.2008.584.
Text Size: A A A
Published online


The article by Pacelli et al1 entitled “Four Hundred Consecutive Total Gastrectomies for Gastric Cancer: A Single-Institution Experience” that was published in the August 2008 issue of Archives raises the question of whether or not all patients with carcinoma of the stomach need total gastrectomy (TG) with D2/D3 node dissection and/or adjacent organ resection. Ever since Bilroth performed the first gastrectomy for carcinoma of the stomach,2 there has been controversy over whether TG or subtotal gastrectomy is the better option for this kind of cancer. Surgeons are convinced that radical subtotal excision for all tumors, “except very proximal tumor[s],”3 result in better overall short- and long-term results. Sasako et al2 recently reported the results of radical TG in a highly selected group of 199 of 523 patients. Their results showed that 5-year overall survival was 69.2% and 5-year disease-free survival was 62.6%, with an overall complication rate of 20.9%. In the series reported by Sasako et al, node-negative patients had a 5-year survival rate of 78.4% and a mortality rate of 0.8%, whereas in Pacelli and colleagues' series, the overall survival rate was 61% in the curative group and only 12.8% in the palliative group (the total overall survival rate was only 37.3%), the overall complication rate was 30.8%, and the overall mortality rate was 4.9%. Such inferior results are due to the fact that the authors performed radical TG in each subset of patients. It will be interesting to know the 5-year disease-free survival rate in their current series.



Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles

The Rational Clinical Examination
Case 2