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Four Hundred Consecutive Total Gastrectomies for Gastric Cancer—Invited Critique
Nita Ahuja, MD
Arch Surg. 2008;143(8):775.
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The article by Pacelli et al highlights, once again, the role of high-volume experienced centers in performing complex operations with low morbidity and mortality. The authors are to be commended for their ability to perform TG and pancreas-preserving D2-D3 lymph node dissections with excellent long-term survival (61.8% at 5 years and 47.3% at 10 years). In this study, 95.5% (298 of 312) of patients underwent R0 resection. However, several points required careful attention.
Although TG is no longer considered the standard for gastric cancer, it may be needed in selected patients with proximal lesions or diffuse-type (linitis plastica) gastric cancer to obtain R0 resection.1 However, the extent of lymphadenectomy in gastric cancer remains controversial. The authors routinely performed pancreas-preserving D2-D3 lymphadenectomy for gastric cancer. Data from several randomized trials and meta-analysis have shown no survival benefit of extended lymphadenectomy. The Dutch Gastric Cancer Group has recently published . . . [Full Text of this Article]
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Four Hundred Consecutive Total Gastrectomies for Gastric Cancer: A Single-Institution Experience
Fabio Pacelli, Valerio Papa, Fausto Rosa, Antonio Pio Tortorelli, Alejandro Martin Sanchez, Marcello Covino, Maurizio Bossola, and Giovanni Battista Doglietto
Arch Surg. 2008;143(8):769-775.
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