Selection of Operative Procedure for Adenocarcinoma of the Midstomach Twenty Yearsʼ Experience with Implications for Future Treatment Strategy

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Abstract
Pathoanatomic studies of the regional spread of adenocarcinoma of the middle 1/3 of the stomach suggested the need for extensive gastric and lymphatic resection. To seek evidence of improved results, a retrospective study was made of 213 patients curatively treated by the following 3 commonly used procedures: radical high subtotal gastrectomy (SG, n = 39), radical total gastrectomy (TG, n = 48), and extended total gastrectomy (ETG, n = 126). The overall 5-yr survival rates were SG 10%, TG 16% and ETG 19%. Advanced stage tumors (N2, N3, or M1) were highly lethal, irrespective of the type of resection. Patients with early stage tumors (T1-4, N0 or N1) showed higher survival rates after more extensive resections (ETG 42% and TG 6 of 8 patients, vs. SG 17%). The highest survival rate (93%) was observed in a subset of patients with early stage tumors electively treated by ETG; this was achieved despite the presence of metastasis to the juxtagastric (N1) lymph nodes or direct invasion of an adjacent organ in most of these patients. The merit of extensive resection for carcinoma of the midstomach was confirmed.