Clinic Study Of Total Gastrectomy On 82 Cases With Gastric Cancer

Objective: To evaluate the clinical value of total gastrectomy and the optimal reconstruction for gastric cancer, analyze the relationship of prognosis and lymphadenectomy. Methods : Clinic data of patients with gastric cancer undergone total gastrectomy in our department from June 1992 to December 2001 were reviewed respectively. Among them 32 patients underwent total gastrectomy with Da lymphadenectomy, while 37 patients underwent total gastrectomy with DS lymphadenectomy. 71 cases were followed up. The overall cumulative probability of survival in K 3 and 5 years were 72.3%- 37.3% and 12.0% respectively. The incidence of complication was 13.6% and operation mortality rate was 2.4% in total gastrectomy. Results: The application of total gastrectomy has risen in our hospital. The cumulative probability of survival of patients with Da lymphadenectomy in 1, 3 and 5 years were 84.3%, 40.6% and 15.7% respectively. The cumulative probability of survival of patients with Da₂-Da₂+ lymphadenectomy in K 3 and 5 years were 55.5%,33.4% and 6.7%. The differences were significant (Log Rank: P=0.035; Breslow: P=0.026).Plasma proteins and hemoglobin decreased significantlier in the Lahey-Braun than that of the Roux-en-Y (P=0.039,P=0.003) and the Roux-en-Y+P (P=0.012,P=0.000) .Although the differences of plasma proteins and hemoglobin between Roux-en-Y+P and Roux-en-Y are not significant, the means of plasma proteins and hemoglobin in Roux-en-Y+P are higher than that in Roux-en-Y. Conclusions: The need of total gastrectomy had increased trend. Da lymph node dissection could improve the postoperative survival. Roux-en-Y+P and Roux-en-Y are better than Lahey-Braun in the reconstruction of alimentary.Roux-en-Y+P may result in a better quality of life.