Gastric cancer: the case for a more selective policy in surgical management

Over a 5-year period 114 patients with gastric cancer were evaluated. Seventy-seven (68%) of these underwent laparotomy, of which 5A (47%) had a resection performed though only 22 (19%) of these were considered curative. Thirty-seven patients (32%) were not offered surgery because they were aged, had poor cardiorespiratory function, or were thought to have advanced disease based on a combination of clinical (fixed epigastric mass, hepatomegaly, jaundice or ascites), radiological and endoscopic features. Overall 5-year survival was 10.9%, with the patients who had curative and palliative resections having 5-year survivals of 24.4% and 18.2% respectively. Eight of the 12 patients who had palliative gastroenterostomy were not satisfactorily palliated, and 9 patients who had 'open and close' laparotomy fared badly with an operative mortality of 44%; mean survival in these two groups was 3.8 and 3 months respectively. Mean survival in patients treated without operation was 5 months. Unit policy in the management of patients with carcinoma of the stomach has been to resect for cure and palliation whenever possible. However, because so many patients present with advanced disease, the avoidance of inappropriate surgery has been an equal priority. In this context, the wider use of ultrasonography, laparoscopy and perhaps computed tomography (CT) may be of help. In this paper, the experience of these 114 patients is reviewed.