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Persons who have cancer of the lower part of the stomach are frequently treated with surgical removal of the entire stomach (called a

total gastrectomy). This extensive surgery is performed to control the cancer and to help prevent recurrence (or return) of the cancer. However, this type of surgery also poses later difficulties for the patient in terms of nutrition and quality of life. Researchers in Italy now report that a less extensive surgery, involving removal of the part of the stomach with cancer only (called a

subtotal gastrectomy), is just as effective as the more extensive procedure.

The researchers assigned 618 persons with cancer of the lower stomach to receive either a total gastrectomy or a subtotal gastrectomy. All patients had localized stage I-III cancer without local or distant spread. Both types of surgery included removal of the nearby lymph nodes. Results showed that, after the procedure, 1% of persons who underwent the subtotal gastrectomy died, compared with 2% who underwent the total gastrectomy. The 5-year survival rates were 65% in those who received the subtotal gastrectomy and 62% in those who received the more extensive procedure. These findings suggest that the 2 treatment outcomes are approximately equal.

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These researchers concluded that, if the upper surgical incision does not reveal cancer, only the lower part of the stomach should be removed in patients with cancer of the lower stomach. The subtotal gastrectomy should result in better nutrition and quality of life compared with total gastrectomy. (

Annals of Surgery, Vol 230, No 2, pp 170-178, 1999)

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