Operative mortality rates with total gastrectomy have declined steadily since 1929,1 resection has been extended, and greater numbers of patients with cancer of the stomach have been deemed operable.2 At the Mayo Clinic, 15% to 20% of patients undergoing operation for cencer of the stomach (90% are classified as operable2) have a total gastrectomy.1 Nakayama, in Japan, reported a mortality rate of 3% in 350 cases.3
The overall picture of total gastrectomy, however, is not reflected in the results of these centers. Most investigators report considerably higher morbidity and mortality. For example, McNeer and Pack4 reported a 25% operative mortality in 200 total gastrectomies performed at Memorial Center for Cancer and Allied Diseases in New York, with a complication rate over 84%. Forty-two percent of anastomoses that leaked proved fatal and accounted for one half of the deaths of patients operated on. These results