This paper presents our experience of total gastrectomy based on 33 cases of gastric cancer treated at the department of general surgery, Presbyterian medical center between Jan. 1964 to August 1969. Our policy has been to perform total gastrectomy in cases of cancer of cardia, fundus, proximal body of the stomach and lintis plastica type in purpose of cure.
1. Total gastrectomy was performed in 3.2% of registered gastric cancer cases and in 5.4% of resectable cases.
2. There was no difference in age, sex, symptoms and its duration as compared with entire group of gastric cancer.
3. Tumors were located in cardia and fundus of stomach in 8 cases, proximal body in 16 cases and entire gastric wall as linitis plastica type in 9 cases.
4. Extended total gastrectomy carried in 8 cases, total gastrectomy without resection of the distal pancreas in 23 cases, total gastrectomy and pancreaticoduodenectomy in 1 case for tumor extention to the head of pancreas, total gastrectomy and Mile´s operation in 1 case for multiple primary mailgnancy in the body of stomach and the rectum.
5. Several methods of anastomosis were used to restore alimentary tract continuity as follows; End to side esophagojejunostomy with Braun anastomosis in 24 cases, Roux-Y esophagojejunostomy in 5 cases, Roux-Y esophagojejunostomy with Lawrence-Hunt pouch in 2 cases and jejunal interposition in 2 cases.
6. Operative mortality was 18.1%. Causes of death were leakage of anastomosis in 2 cases, empyema in 1 case, pneumonitis in 1 case, cardiac arrest during operation in 1 case and postoperative shock in 1 case. Thirteen major postoperative complications occured in 10 patients; Wound infection with or without dehiscence in 4 cases, leakage of anastomosis in 3 cases, empyema in 1 case, pneumonitis in 1 case and thrombophrebitis of the leg in 1 case, bowel obstruction due to adhesion in 3 cases.
7. Sixteen patients survived after the operation. However there was no 5 year survivor because operations carried within 5 years. The longest survival was 3½ years in this series.
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