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Surgical treatment of gastric carcinoma: a retrospective analysis with special regard to the value of total gastrectomy as the operation of choice.

The surgical treatment of gastric carcinoma has been under discussion for many years with regard to the extent of surgical radicality, particularly in terms of total gastrectomy as the operation of choice. The main arguments against this procedure were high postoperative morbidity and mortality as well as poor long-term results, but objective data are not available at this time. Between 1968 and 1987, 1135 resections for gastric carcinomas were performed (714 total, 313 distal subtotal and 108 proximal gastrectomies). During different time periods the incidence of total gastrectomies as a proportion of all resections increased up to 81%. With increased experience the postoperative mortality following total gastrectomy fell to 2%. In this retrospective study no significant differences in the 5-year survival rates between distal subtotal and total gastrectomies could be obtained. However, exact definitions of histopathological features as well as data of epidemiological studies are able to describe more accurately the number of subtotal and total gastrectomies. These characteristics serve as a first step for prospective trials to define the extent of surgical radicality necessary from the oncological point of view with the aim of improving the long-term prognosis of patients with gastric carcinoma individually.