Surgical management of gastric cancer

The presentation and surgical management of gastric cancer is changing as a result of advances in endoscopy and preoperative imaging techniques. One surgeon's experience with 44 cases operated on between 1982 and 1988 is reviewed. Endoscopy was performed in 93% of cases. A sub-total gastrectomy was performed in 23 cases, a total gastrectomy in 13, and a proximal gastrectomy in eight. Of the cancers, 13 involved local or distant structures (d+), 18 had lymph node involvement (+) and 13 were node free (-). Of the first 22 patients, only four had a node (-) lesion compared to nine of the second 22 patients (p = ns). There were two postoperative deaths (4.5%) and eight postoperative complications (20%). Mean hospital stay for (d+) patients (36.2 +/- 22.8 days) was significantly longer than that of the node (-) group (18.3 +/- 5.7 days) (p less than 0.02). Over half the (d+) group died within six months and survival was significantly worse than in the node (-) group for the following three years. No patient in the node (-) group has developed recurrent carcinoma after a mean follow up of 21 months (6 months - 4 years). Early results suggest that subtotal gastrectomy is curative in node (-) patients. Extensive gastrectomies may not be justified in patients with advanced gastric cancer if symptoms do not warrant it, as hospital stay is likely to be prolonged and long term survival is poor.