Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis
M. H. Shiu, E. Moore, M. Sanders, A. Huvos, B. Freedman, J. Goodbold, S. Chaiyaphruk, R. Wesdorp and M. F. Brennan
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.
The therapeutic value of extensive gastric resection and regional
lymphadenectomy in the curative treatment of gastric adenocarcinoma is
controversial. We undertook a retrospective study of 210 patients treated
with curative intent from 1960 to 1980. A multivariate survival analysis
using the Cox model revealed five significant variables predictive of death
from gastric cancer--two inherent pathologic factors: (1) nonpyloric site
and (2) metastases in more than three lymph nodes, and three treatment
factors that could often be controlled by the surgeon: (3) microscopic
positive gastric resection margin, (4) inadequate lymphadenectomy, and (5)
total gastrectomy. These observations reaffirm the value of wide gastric
resection and adequate lymphadenectomy but argue against a general policy
of elective total gastrectomy in the curative treatment of gastric
carcinoma.
