A PROSPECTIVE RANDOMIZED TRIAL COMPARING R(1) SUBTOTAL GASTRECTOMY WITH R(3) TOTAL GASTRECTOMY FOR ANTRAL CANCER

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 R(1) subtotal gastrectomy with omentectomy and R(3) 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 R(1) group and 30 to the R(3) group. The two groups were comparable for age, sex, tumor size, TNM stage, and length of follow-up. The R(3) 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 R(3) group and was caused by intra-abdominal sepsis. Fourteen patients in the R(3) group developed left subphrenic abscesses. There were no major complications in the R(1) group. Overall survival was significantly better in the R(1) group (median survival estimated by Kaplan-Meier method, 1511 vs. 922 days, p<0.05, log-rank test). Conclusions R(3) 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 R(3) total gastrectomy for treatment of patients with antral cancer.