01.12.2017 | Research article | Ausgabe 1/2017 Open Access

The optimal extent of gastrectomy for middle-third gastric cancer: distal subtotal gastrectomy is superior to total gastrectomy in short-term effect without sacrificing long-term survival
- Zeitschrift:
- BMC Cancer > Ausgabe 1/2017
Background
Methods
Patients
Surgical treatments
Clinicopathologic parameters and follow-up
Statistical analysis
Results
Clinicopathologic parameters
Clinicopathological parameters
|
Distal subtotal gastrectomy (
n = 144),
n (%)
|
Total gastrectomy (
n = 195),
n (%)
|
P value
|
---|---|---|---|
Gender
|
0.641
|
||
Male
|
94 (65)
|
132 (68)
|
|
Female
|
50 (35)
|
63 (32)
|
|
Age
|
0.354
|
||
≤ 60
|
87 (60)
|
108 (55)
|
|
> 60
|
57 (40)
|
87 (45)
|
|
Body mass index
|
0.797
|
||
< 19
|
19 (14)
|
27 (14)
|
|
~ <25
|
84 (60)
|
111 (58)
|
|
~ <30
|
31 (22)
|
48 (25)
|
|
≥ 30
|
5 (4)
|
4 (2)
|
|
Neoadjuvant chemotherapy
|
<0.001
|
||
No
|
117 (81)
|
123 (63)
|
|
Yes
|
27 (19)
|
72 (37)
|
|
Differentiation
|
0.117
|
||
Well
|
16 (11)
|
21 (11)
|
|
Moderate
|
63 (44)
|
67 (34)
|
|
Poor
|
65 (45)
|
107 (55)
|
|
Lymphovascular invasion
|
0.015
|
||
No
|
89 (63)
|
96 (50)
|
|
Yes
|
52 (37)
|
97 (50)
|
|
Tumor size
|
<0.001
|
||
≤ 5 cm
|
109 (78)
|
92 (47)
|
|
> 5 cm
|
31 (22)
|
102 (53)
|
|
Location
|
0.038
|
||
Middle
|
88 (61)
|
140 (72)
|
|
Middle-lower
|
56 (39)
|
55 (28)
|
|
Multi-tumor
|
0.699
|
||
No
|
139 (98)
|
192 (99)
|
|
Yes
|
3 (2)
|
3 (1)
|
|
Adjuvant chemotherapy
|
<0.001
|
||
Yes
|
107 (74)
|
186 (95)
|
|
No
|
37 (26)
|
9 (5)
|
|
T stage
|
<0.001
|
||
T1
|
37 (26)
|
12 (6)
|
|
T2
|
19 (14)
|
11 (6)
|
|
T3
|
3 (2)
|
10 (5)
|
|
T4
|
82 (58)
|
182 (83)
|
|
N stage
|
0.027
|
||
N0
|
50 (39)
|
52 (27)
|
|
N1
|
26 (20)
|
30 (16)
|
|
N2
|
19 (15)
|
32 (17)
|
|
N3
|
33 (26)
|
77 (40)
|
Intraoperative and postoperative parameters
Intraoperative and postoperative parameters
|
Distal subtotal gastrectomy
|
Total gastrectomy
|
P value
|
---|---|---|---|
Proximal resection margin, cm, median (25–75% range)
|
5.0 (5.0–5.0)
|
5.0 (4.0–6.0)
|
0.939
|
Total number of dissected lymph nodes, median (25–75% range)
|
26 (18–34)
|
31 (23–43)
|
<0.001
|
Operation duration, min, median (25–75% range)
|
180 (154–213)
|
240 (190–270)
|
<0.001
|
Blood loss volume, ml, median (25–75% range)
|
150 (100–200)
|
150 (100–200)
|
0.178
|
Postoperative hospital stay, days, median (25–75% range)
|
12.0 (10–15.3)
|
14.0 (11.0–19.5)
|
0.001
|
Complication rate,
n (%)
|
12 (8)
|
29 (15)
|
0.047
|
Bleeding,
n (%)
|
2 (1)
|
7 (4)
|
0.311
|
Anastomosis leakage,
n (%)
|
0 (0)
|
8 (4)
|
0.023
|
Obstruction,
n (%)
|
1 (1)
|
1 (1)
|
1.000
|
Peritoneal abscess,
n (%)
|
5 (4)
|
13 (7)
|
0.195
|
Abdominal infection,
n (%)
|
6 (4)
|
17 (9)
|
0.100
|
Pancreatic fistula,
n (%)
|
0 (0)
|
4 (2)
|
0.140
|
Anastomosis stricture,
n (%)
|
0 (0)
|
1 (1)
|
1.000
|
Reoperation,
n (%)
|
3 (2)
|
7 (4)
|
0.527
|
Mortality rate,
n (%)
|
0 (0)
|
3 (2)
|
0.264
|
Survival results
Variable
|
Univariate, hazard ratio (95% Confidence interval)
|
P value
|
|
---|---|---|---|
Gender
|
Male
|
1
|
0.531
|
Female
|
0.898 (0.641, 1.258)
|
||
Body mass index
|
<19
|
1
|
0.841
|
~ < 25
|
0.990 (0.626, 1.565)
|
0.964
|
|
~ < 30
|
1.095 (0.656,1.830)
|
0.728
|
|
≥30
|
0.665 (0.200,2.217)
|
0.507
|
|
Postoperative hospital stay
|
1.001 (0.990, 1.012)
|
0.895
|
|
Reoperation
|
No
|
1
|
0.726
|
Yes
|
1.172 (0.481, 2.859)
|
||
Multi-tumor
|
No
|
1
|
0.147
|
Yes
|
0.259 (0.036, 1.850)
|
||
Total number of dissected lymph nodes
|
1.008 (0.999, 1.018)
|
0.086
|
|
Proximal resection margin
|
0.943 (0.851, 1.044)
|
0.257
|
|
Gastrectomy
|
Distal subtotal gastrectomy
|
1
|
<0.001
|
Total gastrectomy
|
1.894 (1.359, 2.640)
|
||
Location
|
Middle
|
1
|
0.006
|
Middle-lower
|
1.565 (1.137, 2.153)
|
||
Differentiation
|
Well
|
1
|
0.019
|
Moderate
|
1.032 (0.580, 1.837)
|
0.914
|
|
Poor
|
1.609 (0.932, 2.780)
|
0.088
|
|
Blood loss volume
|
1.001 (1.000, 1.002)
|
0.005
|
|
Age
|
≤60
|
1
|
0.002
|
>60
|
1.654 (1.210, 2.260)
|
||
Operation duration
|
1.003 (1.001, 1.005)
|
<0.001
|
|
Complications
|
No
|
1
|
0.015
|
Yes
|
1.708 (1.104, 2.642)
|
||
Neoadjuvant chemotherapy
|
No
|
1
|
<0.001
|
Yes
|
1.791 (1.297, 2.475)
|
||
Adjuvant Chemotherapy
|
No
|
1
|
<0.001
|
Yes
|
10.850 (3.459, 34.033)
|
||
Tumor size
|
≤5 cm
|
1
|
<0.001
|
>5 cm
|
2.828 (2.052, 3.897)
|
||
Lymphovascular invasion
|
No
|
1
|
<0.001
|
Yes
|
2.622 (1.902, 3.615)
|
||
T stage
|
T1
|
1
|
<0.001
|
T2
|
3.961 (1.024, 15.322)
|
0.046
|
|
T3
|
9.944 (2.485, 39.790)
|
0.001
|
|
T4
|
12.988 (4.136, 40.782)
|
<0.001
|
|
N stage
|
N0
|
1
|
<0.001
|
N1
|
2.542 (1.425, 4.532)
|
0.002
|
|
N2
|
3.045 (1.690, 5.487)
|
<0.001
|
|
N3
|
6.562 (4.017, 10.719)
|
<0.001
|
Variable
|
hazard ratio (95% Confidence interval)
|
P value
|
|
---|---|---|---|
Gastrectomy
|
Distal subtotal gastrectomy
|
1
|
0.942
|
Total gastrectomy
|
1.015 (0.677, 1.523)
|
||
Location
|
Middle
|
1
|
0.271
|
Middle-lower
|
1.219 (0.857, 1.735)
|
||
Differentiation
|
Well
|
1
|
0.315
|
Moderate
|
1.218 (0.644, 2.302)
|
0.544
|
|
Poor
|
1.506 (0.813, 2.791)
|
0.193
|
|
Blood loss volume
|
1.001 (1.000, 1.002)
|
0.094
|
|
Age
|
≤60
|
1
|
0.046
|
>60
|
1.401 (1.006, 1.950)
|
||
Operation duration
|
1.004 (1.002, 1.006)
|
<0.001
|
|
Complications
|
No
|
1
|
0.037
|
Yes
|
1.668 (1.031, 2.698)
|
||
Neoadjuvant chemotherapy
|
No
|
1
|
<0.001
|
Yes
|
1.938 (1.362, 2.756)
|
||
Tumor size
|
≤5 cm
|
1
|
0.012
|
>5 cm
|
1.581 (1.108, 2.257)
|
||
Lymphovascular invasion
|
No
|
1
|
0.043
|
Yes
|
1.476 (1.012, 2.151)
|
||
T stage
|
T1
|
1
|
0.069
|
T2
|
0.865 (0.183, 4.094)
|
0.855
|
|
T3
|
2.093 (0.487, 8.995)
|
0.321
|
|
T4
|
2.712 (0.790, 9.311)
|
0.113
|
|
N stage
|
N0
|
1
|
<0.001
|
N1
|
2.234 (1.165, 4.284)
|
0.016
|
|
N2
|
2.236 (1.149, 4.349)
|
0.018
|
|
N3
|
4.416 (2.417, 8.067)
|
<0.001
|