Surgical outcomes and local recurrence following total or subtotal gastrectomy for early adenocarcinoma of antrum

Objective: The choice between total gastrectomy (TG) and subtotal gastrectomy (STG) for early adenocarcinoma of the lower third of the stomach is still a matter of debate and controversy amongst surgeons. The aim of this study was to compare the surgical outcomes, quality of life (QoL), and local recurrence rates as well as other results of curative resection of early distal adenocarcinoma of the stomach using TG or STG performed in Iran. Methods: Hospital records of 66 patients with early distal adenocarcinoma of stomach that underwent even total or subtotal gastrectomy with perigastric (D2) lymphadenectomy between October 2001 and February 2006 in Taleghani Hospital, Iran were reviewed retrospectively. Demographic data as well as clinicopathological factors including number of involved lymph nodes, tumor grading, depth of invation, tumor size, and tumor type were recorded. Post-operative outcomes including mortality and morbidity, tumor recurrence and quality of life were assessed. Univariate analyses using Fisher's exact test, the Student t-test, and the Pearson x2 test were used. Results: Local recurrence of tumor was found in 8 (23) TG group patients and in 19 (61) patients of STG group, the Pearson x2 test showed a significant higher recurrence rate in STG (P value=0.002, Relative Risk=2.68, Confidence Interval: 1.37-5.24).The mean time interval between gastrectomy and tumor recurrence was not different between TG and STG. (19.75±5.1 vs. 18.0±7.8 respectively; P value=0.507) Tumor size >5 cm (P value=0.004), diffuse type (P value=0.034), poor differentiation (P value=0.000) and serosal invasion (P value=0.012) were found to be significantly related to tumor recurrence in patients undergone gastrectomy. In none of the QoL measures a significant difference was found between TG and STG. Conclusion: Our results show that subtotal and total gastrectomy methods with perigastric lymphadenectomy have a similar postoperative complication rate and surgical outcomes as well as patient's QoL but STG was associated to a more than twofold increase in local recurrence risk