Distal Subtotal Gastrectomy for Middle-third Gastric Carcinoma in Selected Patients: Short-term and Long-term Outcomes
Ramiz B Bayramov, Ramila T Abdullayeva and Simara E Huseynova
Journal Title:Acta Scientific Cancer Biology
Objective:Here we describe cases of carcinoma of the middle-third of the stomach for that > 80% distal subtotal gastrectomy was carried out providing adequate proximal resection margin and jejunum was anatomized to the lesser curvature side of the stomach at the level of the esophagogastric junction just below the cardiac sphincter. Material and Methods: From January 2014 till December 2020 54 patients with middle-third gastric carcinoma underwent radi-cal intent surgery. In all of the patients excluding 5 (3 men, 2 women, mean age 62 year) was carried out total gastrectomy (with Roux-en-Y reconstruction) plus D2 lymph node dissection. In the mentioned 5 patients > 80% distal subtotal gastrectomy plus D2 lymph node dissection was carried out providing adequate proximal resection margin. In the reconstruction step of the surgery the greater curvature was invaginated with purse string suture according to the traditional technique and the gastrojejunoanas-tomosis was created to the lesser curvature side of the stomach at the level of the esophagogastric junction just below the cardiac sphincter as mentioned above. The gastrointestinal continuity was reconstructed as an omega loop and in 4 patients, as a Roux-en-Y reconstruction in one. Results: No postoperative complications developed. Oral nutrition started on the 3rd or 4th postoperative days and intravenous infu-sion discontinued on 5th or 6th days. One patient died of multiple liver metastases after 18 months following surgery without any signs of locoregional recurrence. During 3 - 62 months’ control period no patient has complained of the signs of gastroesophageal reflux or dysphagia. 4 patients are alive for 3 - 62 months (mean 38 months) following surgery. Conclusion: In some patients with middle-third gastric carcinoma, who refuse deprivation of the stomach totally or have higher postoperative risk for total gastrectomy, > 80% distal subtotal gastrectomy can be carried out if tumor-free proximal resection mar-gin can be provided.