[Carcinoma of the stomach - our experience with surgical treatment]

Carcinoma of the stomach is among the commonest malignancies of the gastrointestinal tract regardless of the permanent tendency of its diffusion to decrease, observed in the last 25-30 years. The readily accessible methods of diagnosing the disease contribute greatly to its early detection. However, owing to diverse causes, in over 70 per cent of cases the diagnosis is usually made as late as in the advanced III-IV stages. The latter circumstance preordains largely the unfavourable long-term results of the treatment undertaken where surgery plays a major role. It is the purpose of this study to analyze the surgical strategy and tactics currently used in the management of gastric carcinoma. Over a 5-year period (Jan 1995 through Dec 1999), in the Chair of General and Operative Surgery of the Medical University--Sofia a total of 184 gastric carcinoma patients, including 116 men (63.1%) and 68 women (36.9%) with age ranging from 23 to 80 years, undergo operation. Diagnosing is based on past history, physical, laboratory and x-ray data, but first and foremost on evidence from FGS and histological assessment of biopsy material (carried out in all patients). With a view to precise preoperative staging of the lesion, roentgenoscopy + roentgenography of lungs, USD and CAT of the abdominal organs are also done. The following intervention are performed: gastrectomy 18 (9.8%), upper pole resection 43 (23.4%), subtotal resection of stomach 4 (2.2%), prosthetic replacement of cardia 8 (4.3%), derivations 22 (11.9%), and explorative laparotomies. Combined subtotal gastric resections of gastrectomies are necessitated in 73 patients (39.7%) because of carcinomatous infiltration of contiguous organs and/or presence of liver metastases. Morbidity involves 29 patients (15.7%) with lethality amounting to 16 (8.7%). The long-term postoperative results are discussed under a separate heading. Operative treatment of gastric carcinoma patients is the only chance of survival. The scope of indication for more aggressive surgical interventions, including combined resections and gastrectomies, are broadened leading in turn to a considerable reduction of the proportion of explorative laparotomies.