Total versus Subtotal Gastrectomy for Adenocarcinoma of the Gastric Antrum

Abstract

A multicentric randomized trial conducted by the French Associations for Surgical Research tested total gastrectomy (TG) versus subtotal gastrectomy (SG) for adenocarcinoma of the antrum operated with curative intent, in terms of postoperative mortality and 5-year survival. TG was performed in 76 patients and 93 patients underwent SG. Elective TG did not increase postoperative mortality (1.3%) compared with SG (3.2%). There was no statistical difference between the two techniques with regard to 5-year survival (48%). These results were reviewed according to the most recent controversies reported in the literature, i.e. the radicality in lymph node resection enabled by each of the two procedures, the required proximal free margins in SG, the long-term risk of a gastric stump and the nutritional consequences of each technique.