Journal of Gastric Cancer

  • 제10권4호
  • /
  • Pages.226-233
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  • 2010
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  • 2093-582X(pISSN)
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  • 2093-5641(eISSN)
대한위암학회 (The Korean Gastric Cancer Association)
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Which Is the Optimal Extent of Resection in Middle Third Gastric Cancer between Total Gastrectomy and Subtotal Gastrectomy?

  • Lee, Ji-Hyun (Department of Surgery, School of Medicine, Ewha Womans University) ;
  • Kim, Yong-Il (Department of Surgery, School of Medicine, Ewha Womans University)
  • 투고 : 2010.09.27
  • 심사 : 2010.10.08
  • 발행 : 2010.12.30
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초록

Purpose: In resectable gastric cancer, choice regarding the extent of resection depends on tumor size, location, and distance from resection margin. However, there remains controversy for choice of resection for tumors in the middle third of the stomach. This study investigated patients who underwent gastrectomy in order to analyze the differences between total gastrectomy (TG) and subtotal gastrectomy (STG). Materials and Methods: From 2000 to 2006, 125 patients with a tumor in the middle third of the stomach underwent radical gastric resection at EUMC. We retrospectively conducted comparative analysis for the differences in clinicopathological characteristics and prognosis between TG and STG. Results: The average tumor size was 6.7 cm for TG, and 4.1 cm for STG. The number of metastatic lymph nodes were 13.3 for TG, and 3.7 for STG. Patients with more advanced cancer were more likely to receive TG. The 5-year survival rate for TG was lower (38.1%) than STG (69.0%). However, if tumor stages were stratified, there was no significant difference in the survival rate. Histologically, for the undifferentiated type of cancer (Stage 1, 2), the 5-year survival rate of STG was higher (88.1%) than TG (75.0%). Conclusions: Comparing patients with tumors in the middle third of the stomach who underwent TG and STG, there was no statistically significant difference in the 5-year survival rate. If stages were stratified, the clinicopathological characteristic becomes a key factor in deciding the prognosis, rather than the choice of resection. Thus if the radical resection margin can be obtained for a tumor in the middle third of the stomach, STG is considered instead of TG.

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참고문헌

  1. Sim YK, Kim CY, Jeong YJ, Kim JH, Hwang Y, Yang DH. Changes of the clinicopathological characteristics and survival rates of gastric cancer with gastrectomy: 1990s vs early 2000s. J Korean Gastric Cancer Assoc 2009;9:200-206. https://doi.org/10.5230/jkgca.2009.9.4.200
  2. Kim W, Park CH, Park SM, Park WB, Lim KW, Kim SN. Prognostic significance of lymphatic and perineural invasions in patients with gastric cancer who have no lymph node and serosal involvement. J Korean Gastric Cancer Assoc 2001;1:77-82. https://doi.org/10.5230/jkgca.2001.1.2.77
  3. http://www.cancer.go.kr/cms/statics/mortality/index.html/ Accessed July 4, 2010
  4. Billroth T. Offenes schreiben an Herrn Dr. L. Wittelshofer. Wien Med Wochenschr 1881;31:161-165.
  5. Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg 2005;241:27-39.
  6. Stein HJ, Sendler A, Siewert JR. Site-dependent resection techniques for gastric cancer. Surg Oncol Clin N Am 2002;11:405-414. https://doi.org/10.1016/S1055-3207(02)00017-0
  7. Clark CJ, Th irlby RC, Picozzi V Jr, Schembre DB, Cummings FP, Lin E. Current problems in surgery: gastric cancer. Curr Probl Surg 2006;43:566-670. https://doi.org/10.1067/j.cpsurg.2006.06.003
  8. Bozzetti F, Bonfanti G, Bufalino R, Menotti V, Persano S, Andreola S, et al. Adequacy of margins of resection in gastrectomy for cancer. Ann Surg 1982;196:685-690. https://doi.org/10.1097/00000658-198212001-00012
  9. Jang YJ, Park MS, Kim JH, Park SS, Park SH, Kim SJ, et al. Advanced gastric cancer in the middle one-third of the stomach: Should surgeons perform total gastrectomy? J Surg Oncol 2010;101:451-456.
  10. Sobin L, Gospodarowicz M, Wittekind C, eds. TNM Classification of Malignant Tumors. 7th ed. International Union Against Cancer (UICC). New York: Weiley, 2009.
  11. Davies J, Johnston D, Sue-Ling H, Young S, May J, Griffi th J, et al. Total or subtotal gastrectomy for gastric carcinoma? A study of quality of life. World J Surg 1998;22:1048-1055. https://doi.org/10.1007/s002689900515
  12. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Crose N, et al. Total versus subtotal gastrectomy: surgical morbidity and mortality rates in a multicenter Italian randomized trial. The Italian Gastrointestinal Tumor Study Group. Ann Surg 1997;226:613-620. https://doi.org/10.1097/00000658-199711000-00006
  13. Bozzetti F, Marubini E, Bonfanti G, Miceli R, Piano C, Gennari L. Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Italian Gastrointestinal Tumor Study Group. Ann Surg 1999;230:170-178. https://doi.org/10.1097/00000658-199908000-00006
  14. Kim IH, Kim YC, Kim SM. Prognosis of total and proximal gastrectomy for gastric cancer. J Korean Surg Soc 1986;31:545-555.
  15. Lim HJ, Jeong YJ, Yang DH. A comparative study on the outcomes of total and proximal gastrectomies performed for gastric cancer. Korean J Gastroenterol 2002;40:364-370.
  16. Gouzi JL, Huguier M, Fagniez PL, Launois B, Flamant Y, Lacaine F, et al. Total versus subtotal gastrectomy for adenocarcinoma of the gastric antrum. A French prospective controlled study. Ann Surg 1989;209:162-166. https://doi.org/10.1097/00000658-198902000-00005
  17. Braga M, Molinari M, Zuliani W, Foppa L, Gianotti L, Radaelli G, et al. Surgical treatment of gastric adenocarcinoma: impact on survival and quality of life. A prospective ten year study. Hepatogastroenterology 1996;43:187-193.
  18. Oh CA, Kim DH, Oh SJ, Choi MG, Noh JH, Sohn TS, et al. Changes of the preoperative and postoperative nutritional statuses in patients with gastric cancer and assessment of the nutritional factors that are correlated with short-term postoperative complications. J Korean Gastric Cancer Assoc 2010;10:5-12. https://doi.org/10.5230/jkgca.2010.10.1.5
  19. Bozzetti F, Ravera E, Cozzaglio L, Dossena G, Agradi E, Bonfanti G, et al. Comparison of nutritional status aft er total or subtotal gastrectomy. Nutrition 1990;6:371-375.
  20. Rohatgi PR, Yao JC, Hess K, Schnirer I, Rashid A, Mansfi eld PF, et al. Outcome of gastric cancer patients aft er successful gastrectomy: infl uence of the type of recurrence and histology on survival. Cancer 2006;107:2576-2580. https://doi.org/10.1002/cncr.22317
  21. Gospodarowicz M, Benedet L, Hutter RV, Fleming I, Henson DE, Sobin LH. History and international developments in cancer staging. Cancer Prev Control 1998;2:262-268.
  22. Sobin LH. TNM: principles, history, and relation to other prognostic factors. Cancer 2001;91(8 Suppl):1589-1592.
  23. Ha TK, Kim HJ, Kwon SJ. Does the new UICC/AJCC TNM staging system (7th Edition) improve assessing prognosis in gastric cancer compared to the old system (6th Edition)? J Korean Gastric Cancer Assoc 2009;9:159-166. https://doi.org/10.5230/jkgca.2009.9.4.159
  24. Deng J, Liang H, Sun D, Wang D, Pan Y. Suitability of 7th UICC N stage for predicting the overall survival of gastric cancer patients after curative resection in China. Ann Surg Oncol 2010;17:1259-1266. https://doi.org/10.1245/s10434-010-0939-x
  25. McNeer G, Bowden L, Booner RJ, McPeak CJ. Elective total gastrectomy for cancer of the stomach: end results. Ann Surg 1974;180:252-256. https://doi.org/10.1097/00000658-197408000-00022

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