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KMID : 0352119960120030296
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Journal of Kyung Hee University
1996 Volume.12 No. 3 p.296 ~ p.305
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Total Gastrectomy for the Gastric Cancer with Special Reference to an Abdominal Approach
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남궁환
박호철/윤충/주홍재/이행철/이양삼
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Abstract
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When tumor is left at the esophageal transsection line after total gastrectomy, both operative mortality and survival are adversely affected. Thus a number of methods have been suggested to avoid leaving tumor at the resection margins. In an
attempt to
assess the effect of this knowledge on the surgical practice, we have analyzed 204 patients with gastric cancer treated with total gastrectomy during the 9 year period from January 1986 to December 1994 at the Department of Surgery, KyungHee
University
Hospital
@ES The results are as follows:
@EN 1) During 9 years, we performed operative treatment in 1159 patients with gastric cancer. Amomg them 209 cases (18.0%) were performed by total gastrectomy.
2) The most frequent age group was 6th decade(35.8%) and male to female ratio was 2.1:1.
3) The most common site of tumor was upper third of the stomach (69 cases:33.8%). 21cases (10.3%) of them showed esophageal invasion.
4) The curative operation was possible in 169 cases (83.8%). Extended operations were performed in 76 cases (37.3%) and in 18 cases (23.7%) due to direct tumor invasion. Extended esophageal resections were done with thoracotomy in 5 and with
transhital
approach in 2. Reconstruction was achieved by Rouxen-Y method in most cases and a autosuture was used in every cases except 3.
5) Major operative morbidity occurred in 74 cases (36.3%) and operative mortality was 1.96%.
6) Among the 169 patients who underwent curative operation, follow up of recurrence was possible in 144 cases. Recurrence occurred in 54 cases in this peried and the most common type of recurrence was peritoneal dissemination followed by distant
metastasis and local recurrence. Local recurrence at the anastomotic site was observed in 7 cases.
7) Of 204 cases, follow up of survival was possible in 183 cases. Overall 5-year survival rate was 30.1%.
8) In analysis of 159 cases which have negative frozen result through an abdominal approach, anastomotic leakage and local recurrence was slightly many in the cases with grossly inadequate resection margin. But, there was no significant
statistical
difference. And mean survival was long in the cases with grossly adequate resection margin. But, the difference was not significant statistically.
In conclusion, there was no significant difference in anastomotic leakage, local recurrence, and survival according to gross resection margin in the cases of negative frozen result through an abdominal approach. So, if the frozen results are
negative,
although the resection margin are grossly inadequate, we believe that abdominal approach is an appropriate alternative to more extended operation.
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KEYWORD
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