Gastric Linitis Plastica is Not a Surgical Disease

In a 10-year period, 26 patients with gastric linitis plastica were identified at our institution. The 26 fell into two groups: In group I (nonresection group) seven underwent laparotomy and biopsy, three laparotomy, biopsy, and jejunostomy, and three patients were not explored; in group II (resection group) eight patients underwent total gastrectomy, two subtotal (85%) gastrectomy, one total gastrectomy with thoracic esophagectomy, one total gastrectomy with segmental resection of the tranverse colon, and one total gastrectomy with subtotal pancreatectomy and splenectomy. There was one postoperative death in each group. In group II morbidity consisted of an anastomotic leak in one, pancreatic fistula in two, and pancreatitis in one patient. Mean survival of group I patients was 6.6 months. The mean survival of group II patients was 7.2 months. Patients who underwent total gastrectomy in the presence of peritoneal or liver metastasis lived 4 months. Those who underwent total gastrectomy in the presence of pancreatic involvement lived 4 months. Patients who underwent total gastrectomy for disease limited to the stomach and regional lymph nodes lived 13.6 months. Total gastrectomy for linitis plastica should be performed in those patients who have disease limited to the stomach or regional lymph nodes. Other patients should be offered alternative forms of treatment, including chemotherapy and radiation therapy.