[Current aspects of stomach cancer. Surgical experience]

The incidence of gastric carcinoma is variable through the world. This incidence has significantly decreased during recent decades, in France and in industrialized countries. The decline of gastric carcinoma is attributable to changes in the living habits and mostly to preservation of foodstuffs by refrigeration; it is explained by the decrease in number of intestinal or differentiated histologic type carcinomas according to the Lauren's classification; on the contrary, diffuse or poorly differentiated histologic type carcinomas became more common in France and in low-risk areas, but is it a relative or an absolute increase? There has been also an unexplained change in location of the tumor with a decreasing incidence in the cancers occurring in the prepyloric area and an increasing incidence in those occurring in the gastric cardia area. Early gastric carcinoma should be really a precursor of the invasive gastric carcinomas. Diagnosis of gastric carcinoma is now based on gastroscopy and biopsy of the lesion. Tumoral extension through the gastric wall and nodal involvement can be appreciated by endoscopic sonography. The procedure (subtotal versus total gastrectomy) depends on the site and extent of the lesion. Elective total gastrectomy is not advocated in patients with carcinoma of the antrum. The value of extended lymph node dissection commonly performed in Japan, is still controversial in Western countries. In patients with carcinoma of the gastric cardia, there is controversy concerning the approach and type of resection, in relation with the frequent esophageal and mediastinal extension of the tumor. In a global series including 408 operated patients, the 5-year survival rate was 51% after resection with curative intent and the overall 5-year survival was 28%.(ABSTRACT TRUNCATED AT 250 WORDS)