Total gastrectomy (TG) versus distal gastrectomy (DG) for distal diffuse gastric cancer (GC).

Abstract

305 Background: Diffuse gastric cancer (GC) in advanced stages has a poor prognosis. There is no clear consensus regarding the extent of surgical procedure for distal diffuse GC. Most surgeons prefer to perform total gastrectomy (TG) to achieve more radicality and reduce a local recurrence rate. Perhaps, the distal gastrectomy (DG) is not worse in terms of survival rates in distal diffuse GC compared with TG. Methods: The retrospective analysis was undertaken of 125 patients with distal diffuse gastric cancer. These patients received TG or DG at the N.N. Blokhin National Medical Research Center of Oncology in period from January 2005 to December 2022. We compared clinical, pathological features and survival rates between these groups. Results: Univariate analysis revealed that depth of tumor invasion, lymph nodes status and stage of the disease were associated with OS (p<0.05). Resection margin (R1) tended to be associated with OS (p=0.082). Multivariate analysis revealed that only stage of the disease was associated with OS (p<0.05). The median OS, 5-year OS in the DG group were 85,0 months, 58,8% (95% CI: 0.487-0.711). The median OS, 5-year OS in the TG group were 89,0 months, 60,3% (95% CI: 0.460-0.791). The differences in OS were not statistically significant between these groups (p=0.75). Such high overall survival rates were received because the 67,2% of patients had I-II stage of the disease. In our study only 84 patients were able to be followed-up after surgery: 63 (75%) in DG group and 21 (25%) in TG group. In the DG group intramural recurrence was detected in 12,7% of all cases of recurrence (8/63): 6 of them with intramural recurrence and 2 of them with synchronous intramural recurrence and distant metastasis. In the TG group intramural recurrence was detected only in one (4,8%) patient. Only 2 patients in DG group had R1-margin after primary surgery. Conclusions: DG for distal diffuse gastric cancer is associated with higher rate of intramural recurrence (12,7%) and cannot be recommended as an alternative to TG in patients with satisfactory functional status.