Carcinoma of the stomach: the need for a new approach

An analysis was performed of 229 cases of carcinoma of the stomach presenting between 1970 and 1975 and followed up until 1980. The average age of the patients was 67 years with a range of 24 to 96 years. The predominant symptoms were weight loss, epigastric pain, anorexia, vomiting and an abdominal mass of two of 18 months duration. All cancers were adenocarcinomata, most commonly in the distal third of the stomach; most were bulky (T3) on diagnosis and of poor histological differentiation. Some tumours had not spread to nodes but most had nodal involvement of the first and second order. Over half showed evidence of wide-spread dissemination at presentation. The operative mortality of all procedures including curative resection, palliative resection and by-pass was high, reflecting the high exploration rate (81.6%), high resection rate (56%) and the extent and hazards of major operation. Total gastrectomy was associated with twice the operative mortality of subtotal gastrectomy. Five year survival was in each case 17.3% and 16.3% respectively but it should be noted that the larger, more bulky and infiltrative tumours could not have been dealt with by anything less than total gastric resection. Average survival time in the "curative" surgery group was 27.9 months and of all 229 patients presenting, only 11 (4.8%) were alive after five years. Factors which may lead to improvement in this dismal outlook are discussed. Earlier diagnosis and multimodal chemotherapy as an adjunct to traditional surgery appear to offer the greatest prospects of improvement.