Surgical and combined treatment of gastric cancer--own experience

In Poland, as well as all over the world, gastric cancer is still among the leading causes of mortality and morbidity from malignant diseases. Many attempts were made to improve the results of the treatment. In this paper we present our 25-year experience in this field.

From 1977 to 2000 in the Clinical Department of Surgical Oncology, Medical University of Łódź, we treated 353 patients (males 63%; females 37%) with the diagnosis of gastric cancer, confirmed histologically. We analysed the age of patients, location of primary tumor, histologic type, stage of the disease, type of surgery, type of reconstruction of GI tract, type of adjuvant therapy and survival.

In patients with the disease in stage I and II according to UICC Fielding classification, the best results were achieved. Five year survival reached 76% which means that early recognised gastric cancer may be cured. However, patients from this group constituted only 6.7% of all the treated population. In patients with stage III disease, 5 year survival was 34.5%. In patients with IVA stage of the disease (72 cases), in whom only cytoreductive-palliative surgery was performed, 5-year survival was 16.7%. No patient with IVB stage of the disease (purely palliative procedures performed) survived 5 years. Significant improvement of distant results was, observed in patients receiving EAP as an adjuvant therapy (25.1% of 5-year survivors) in comparison to control group patients treated solely with surgery (18.2% of 5 year survivors). In 97 patients after total gastrectomy, significantly lower complication rate was observed in patients in whom intestinal pouch was created (Hunt-Lawrence) than in patients in whom the pouch was not created (Roux-Y, Engel-Graham).

In our opinion, we should consequently implement guidelines known as the "Polish Consensus of Gastric Cancer Treatment", like extensive radical stomach resection (whenever possible) with regional lymphadenectomy and adjuvant therapy.