TOTAL OR SUBTOTAL GASTRECTOMY FOR GASTRIC-CARCINOMA - A STUDY OF QUALITY-OF-LIFE

The aim of this study was to compare quality of life after total gastr ectomy (TG) with that after subtotal gastrectomy (STG) for gastric car cinoma. The value of the routine use of TG de principe in the treatmen t of gastric carcinoma, wherever the tumor may be sited in the stomach , remains controversial. The advocates of TG contend that when it can be performed safely, with relatively low operative mortality and morbi dity, it yields better long-term survival than STG. Most surgeons, how ever, believe that the routine use of TG increases both operative mort ality and morbidity and the risk of nutritional deficiency in the long term, without improving survival. TG may also be associated with poor er outcome in terms of quality of life (QOL), but the evidence for thi s is tenuous. Forty-seven consecutive patients who had undergone poten tially curative (RO) gastric resection for carcinoma were studied: 26 had undergone TG and 21 STG. A radical D2 lymph node dissection had be en performed in each, and all patients were free from recurrence at th e time of the study. QOL was measured before operation and 1, 3, 6, an d 12 months after operation by means of five questionnaires to measure functional outcome: the Rotterdam symptom checklist (RSCL), the Troid l index, the hospital anxiety and depression (HAD) scale, activities o f daily living score, and Visick grades. Before operation there was no significant difference in QOL between the two groups of patients. At 1 year after operation, however, patients who had undergone STG had a significantly better QOL than patients who had undergone TG: Their med ian RSCL score was lower (10 versus 19 respectively, p < 0.05), and th eir Troidl index was higher (11 versus 9 respectively, p < 0.05). The QOL of patients who underwent STG was also significantly better after operation than it had been before operation, whereas the QOL of the TG group was not significantly better after operation than before operat ion. The QOL of patients was found to be significantly better after ST G than after TG for gastric carcinoma. Because operative mortality is greater and long-term survival is no better after TG than after STG, t he latter is recommended as the treatment of choice for tumors of the distal stomach.