[Problems in the surgical treatment of gastric cancers]

Radical resections were performed in 177 cases of gastric cancer (early cancer 31 cases and advanced cancer 146 cases). R+1 operation was performed in 10 cases and R2 or R3 was in 167. All patients were followed up to the end of the study with the 5-year survival rate of 57.6%. In the patients with normal serosa, cancer was often located in the mucosa. In such situation, R1 or R1+ operation was advisable. In the patients of reactive serosal types, the extent of operation should not be reduced. The serosa were often penetrated by cancer cells in diffusely infiltrated cancer, with a poor prognosis. If measures were not taken to destroy free cancer cells, the 5-year survival rate was very low inspite of radical operations. The number of lymph node metastasis was closely related to the biological behavior of primary cancer. Prognosis was good after R2 or R3 operation when the cancer was still within the gastric wall, Borrmann type 1,2,3, massive or nest growth patterns, and the number of lymph node metastasis was below 5 and within first group (n1). If the number of lymph node metastasis was above 10, metastasis to the second (n2) or third group (n3), the cancer infiltrated to the serosa, Borrmann type 4, diffused growth pattern the prognosis was poor even R2 or R3 operations were performed.