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[Results of the surgical treatment of gastric cancer. A retrospective study of 247 cases].

Controversies still exist regarding the surgical treatment of gastric cancer. The therapeutic value of lymphoadenectomy (staging or curative) and the amount of the stomach exeresis for the lower third location are particularly debated. The authors discuss about their experience on 247 patients with gastric cancer of which 148 treated with exeresis (total and subtotal gastrectomy). In the greater number of patients (130 cases) a R2/R3 lymphadenectomy was performed. The global 5-years survival rate was 26.5%. Concerning the lower third localization the 5-years survival rate was 33.5% for total gastrectomy and 24.5% for subtotal gastrectomy with no significant difference (chi-square test: p = .6235). In 31 patients in which there was N2 involvement the 5-years survival rate was 19.2%. They conclude that this result confirm the opportunity to perform a R2/R3 lymphoadenectomy whose value can be considered curative in the cases with N2 involvement and of staging in the N3 positive. They underline that the possibility to perform a less aggressive lymphoadenectomy (R1/R2) in the early gastric cancer, must be considered after an objective evaluation of the depth of tumor invasion in the gastric wall.