Local recurrence following total or subtotal gastrectomy for adenocarcinoma of the antrum

This study aimed to compare the recurrence rate, mortality, and morbidity of curative resection of distal adenocarcinoma of the stomach between total gastrectomy (TG) and subtotal gastrectomy (STG). The choice between TG and STG for adenocarcinoma of the lower third of the stomach is still a matter of debate and controversy among surgeons.Patients and Hospital records of 66 patients with distal adenocarcinoma of stomach, which had undergone even-total or subtotal gastrectomy between October 2001 and February 2006 in Taleghani hospital, Iran were reviewed retrospectively. Demographic data and clinicopathological factors were recorded. Post-operative outcomes including mortality, morbidity and tumor recurrence were assessed. Univariate analyses using Fisher''s exact test, the Student t-test, and the Pearson? 2 test were used. P values less than 0.05 were considered statistically significant. Recurrence rate was higher in STG than TG (61% vs. 23%, RR=2.68, 95% CI=1.37-5.24, P=0.002). 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 months, P=0.507). Tumor size >5 cm (P=0.004), diffuse type (P=0.034), poor differentiation (P=0.001) and serosal invasion (P=0.012) were found to be significantly related to tumor recurrence in patients who had undergone gastrectomy. Subtotal and total gastrectomy techniques have similar surgical outcome and postoperative complication rate; however, STG is associated with a more than twofold increase in local recurrence risk.