Choice of operative procedure for adenocarcinoma of the gastric antrum: A study based on TNM classification

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Abstract
This is a retrospective study comparing the results of distal subtotal (DST), total (T), and extended total (ET) gastrectomy in a group of 143 patients with adenocarcinomas of the antrum. Of those, 52 had TNM stage I and II tumors and 91 had stage II and IV tumors. Operative mortality was 10% with DST, 23% with T, and 16% with ET. The incidence of recurrence of the tumor at the gastrectomy site was 26% for DST, 27% for T, and only 9% for ET. In stages I and II, the difference of recurrence in favor of ET was significant (P < 0.05). Analysis of survival data without TNM staging showed no significant difference between the three procedures. TNM staging indicated that that surgical treatment, regardless of procedure, salvaged only five out of 91 stage III and IV patients. The choice of procedure made a difference only in stages I and II, where ET was associated with a significantly higher survival than DST (P < 0.02). The study suggested that intraoperative staging might be of value in selecting the proper type of gastrectomy. This could be accomplished with node sampling because tumor size corresponds poorly with TNM stage.