1114 Total gastrectomies in the surgical treatment of primary gastric adenocarcinoma - A 30-year single institution experience

Background/Aims: Surgical therapy still represents the standard treatment f or gastric carcinoma. Due to epidemiology and tumor stage, total gastrectom y is the most often required extent of gastric resection to obtain a potent ially curative status. After a 30-year period we overviewed 1114 total gast rectomies, to our knowledge one of the biggest single-institution series in the Western Hemisphere. Methodology. Among 1991 cases with gastric carcinoma, treated between May 1 968 and February 1998, 1114 patients underwent total gastrectomy. This pros pectively documented series was retrospectively analyzed with special focus on various time periods. Results: A constant increase of proximal gastric carcinomas was noted. RO-r esections were feasible in 84.6% of total gastrectomies. Morbidity and mort ality decreased to 22.2% and 5.5%, respectively, in the last decade. Overal l 5-years survival rate was 32.4%. Survival was strongly influenced by tumo r stage and R-classification. Overall and prognosis after R0-resection show ed a significant time-dependent improvement. Conclusions: Total gastrectomy requires intensive surgical skills and can b e performed with acceptable morbidity and low mortality. Survival after tot al gastrectomy can be improved with increasing experience, and the aim of t otal gastrectomy for gastric carcinoma should always focus on a R0-resectio n.