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1114 total gastrectomies in the surgical treatment of primary gastric adenocarcinoma--a 30-year single institution experience.

BACKGROUND/AIMS
Surgical therapy still represents the standard treatment for gastric carcinoma. Due to epidemiology and tumor stage, total gastrectomy is the most often required extent of gastric resection to obtain a potentially curative status. After a 30-year period we overviewed 1114 total gastrectomies, to our knowledge one of the biggest single-institution series in the Western Hemisphere.


METHODOLOGY
Among 1991 cases with gastric carcinoma, treated between May 1968 and February 1998, 1114 patients underwent total gastrectomy. This prospectively documented series was retrospectively analyzed with special focus on various time periods.


RESULTS
A constant increase of proximal gastric carcinomas was noted. R0-resections were feasible in 84.6% of total gastrectomies. Morbidity and mortality decreased to 22.2% and 5.5%, respectively, in the last decade. Overall 5-years survival rate was 32.4%. Survival was strongly influenced by tumor stage and R-classification. Overall and prognosis after R0-resection showed a significant time-dependent improvement.


CONCLUSIONS
Total gastrectomy requires intensive surgical skills and can be performed with acceptable morbidity and low mortality. Survival after total gastrectomy can be improved with increasing experience, and the aim of total gastrectomy for gastric carcinoma should always focus on a R0-resection.