Early results of extended total gastrectomy for cancer

HE standard surgical techniques of sub-T total or even total gastrectomy have cured an appreciabIe number of patients of carcinoma of the stomach.A large number of patients with similar operative findings and type of resection have been less fortunate, however, and died of recurrent cancer.Dissatisfaction with this stalemate has forced search for a new approach to the surgical treatment of carcinoma of the stomach.It was found in an autopsy study of ninetytwo failures of partial gastrectomy for cancer that 50 per cent of these patients had recurrence in the gastric remnant.Almost one quarter of the patients studied had residual cancer in the regional lymphatic "bed."5An operation considered the "maximum surgical effort" was therefore designed to extend the removal of the primary lesion and its local lymphatic metastases beyond the operative field of standard techniques.T h e technical features of this "extended total gastrectomy" have been described previously.4Basically the operation entails excision, en bloc, of the entire stomach, greater and lesser omenta, spleen, body and tail of the pancreas, and contiguous ligaments and fascia (Fig. 1).I n addition to removal of perigastric lymph nodes on both curvatures from the esophagus to the duodenum, this extended total gastrectomy includes the pancreatolienal and lienal lymph nodes.T h e sites of node metastases in the series reported here were studied by a thorough microscopic examination of all lymph nodes found after subjecting the gross specimens to a special clearing technique.This pathological study was reported in part previously.6Many surgeons have reported the resection