Subtotal versus total gastrectomy for distal diffuse-type gastric cancer

Jorge A Gajardo; Francisco J Arriagada; Florencia D Muñoz; Francisca A Veloso; Francisco A Pacheco; Hector E Molina; Thomas P Schaub; Osvaldo A Torres

doi:10.1007/s00464-024-11268-x

Subtotal versus total gastrectomy for distal diffuse-type gastric cancer

Surg Endosc. 2024 Sep 23. doi: 10.1007/s00464-024-11268-x. Online ahead of print.

Authors

Jorge A Gajardo^{1

2}, Francisco J Arriagada³, Florencia D Muñoz³, Francisca A Veloso³, Francisco A Pacheco^{4

3}, Hector E Molina^{4

3}, Thomas P Schaub^{4

3}, Osvaldo A Torres⁴

Affiliations

¹ Upper Gastrointestinal Surgery Unit, Hospital Guillermo Grant Benavente, Concepción, Chile. drjorgegajardo@gmail.com.
² Facultad de Medicina, Universidad de Concepción, Chacabuco Esq. Janequeo S/N, Concepción, Chile. drjorgegajardo@gmail.com.
³ Facultad de Medicina, Universidad de Concepción, Chacabuco Esq. Janequeo S/N, Concepción, Chile.
⁴ Upper Gastrointestinal Surgery Unit, Hospital Guillermo Grant Benavente, Concepción, Chile.

PMID: 39313583
DOI: 10.1007/s00464-024-11268-x

Abstract

Introduction: Diffuse-type gastric carcinoma in an aggressive form of gastric cancer. Surgery is the only potentially curative treatment. It is controversial whether patients with diffuse-type gastric carcinoma should undergo total or subtotal gastrectomy when feasible. The aim of this study is to analyze the oncologic outcomes and overall survival of patients diagnosed with distal diffuse-type gastric cancer undergoing subtotal versus total gastrectomy with curative intent.

Methods: This retrospective study included all patients with histologically confirmed diffuse-type distal gastric carcinoma and clinical staging cT1-4M0, who underwent surgery with curative intent between 2011 and 2020 in a Tertiary Referral Hospital in Chile. Clinical and pathological staging was conducted using the 8th Edition of the American Joint Committee on Cancer Classification. STG group was comprised by patients who underwent subtotal gastrectomy and TG group by patients who underwent total gastrectomy. Both groups were compared in relation to sociodemographic variables, pathology reports and perioperative data which were obtained from electronic medical records. Data analysis was obtained with Stata 16.1 Statistical Software.

Results: One hundred and thirty patients underwent curative intent surgery. Subtotal gastrectomy with D2-lymphadenectomy was completed in 68 patients (52%). An R0 resection was achieved in all patients. Median number of resected lymph nodes, tumor size, proximal margin and depth of invasion were similar in both groups. Pathologic staging was similar between both groups, the most frequent being Stage 3(54%). After a median follow-up of 47 months [0.3-157], no difference was observed in overall survival between both groups (5-year-OS 63% in STG group versus 51% in TG group, p = 0.097).

Conclusions: Oncologic and survival outcomes were similar in patients submitted to subtotal and total gastrectomy, suggesting that a subtotal gastrectomy with D2-lymphadenectomy for distal diffuse-type gastric carcinoma is not associated with a decrease in median overall survival and is an adequate surgical approach when technically feasible.

Keywords: Diffuse gastric cancer; Gastric cancer; Gastric cancer surgery.