The effectiveness of Appleby's operation in advanced gastric carcinoma

This study was undertaken in order to evaluate the effectiveness of Appleby's operation on the postoperative survival rate as compared with that of conventional total gastrectomy accompanying pancreatosplenectomy and that of subtotal gastrectomy with lymph node dissection of the conventional style preserving the spleen and the pancreas. In our study Appleby's operation was performed in 65 cases and the conventional procedures were in 41 cases and 50 cases, respectively. Both groups have almost identical prognostic backgrounds except for the lymph node status. The overall 5-year survival rate of Appleby's procedure group was higher (49.5%) than that of the conventional procedure group (23%) in spite of higher percentage of positive rate of the 2nd group of lymph node(n2+) in Appleby's procedure group. Furthermore, in the cases with serosal invasion(se) and positive metastasis in the 1st group of lymph node (n1+), the 5-year survival rate of Appleby's procedure group was higher (64%) than that of the conventional procedure group (32%), and the difference was statistically significant (p less than 0.01). On the other hand, no difference was observed in the 5-year survival rate between both groups in which the serosae were invaded and the 2nd group of lymph nodes were involved. Our study shows that Appleby's procedure salvaged further 32% of patients that would have been lost if they had undergone the conventional procedure.