Gastric carcinoma. A 25-year experience

The case records of 101 patients operated on for adenocarcinoma of the stomach at one hospital over a 25-year period were reviewed. Generally, the patients had advanced disease (80% had Stage III or Stage IV tumors) at the time of treatment. Curative procedures were possible in only 46 patients and yielded a five-year survival rate of 16.7 per cent. The overall operative mortality rate was 25 per cent, although in the last decade that rate decreased to 15 per cent. Good palliation in the early months was achieved with both subtotal gastric resection and bypass gastrojejunostomy. Because of patient selection, however, the palliation provided by bypass was of shorter duration (mean less than six months). The main reason for these disappointing results was the advanced stage of the cancer at the time of diagnosis and treatment. The prognosis for patients with gastric cancer clearly correlates with the stage of the disease at the time of operation. Surgical resection provides the most effective relief of symptoms and offers the only hope of cure. The importance of diagnosing gastric cancer early when the tumor is still confined to the stomach wall is emphasized and recommendations for achieving this goal are discussed.