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Gastric cancer: a curable disease in Britain
H M Sue-Ling1, D Johnston, I G Martin
1Academic Unit of Surgery, Centre for Digestive Diseases, General Infirmary, Leeds.
Objective:
To determine whether more vigorous efforts aimed at earlier diagnosis allied to radical surgical resection lead to improved survival of patients with gastric cancer.
Design:
Prospective audit of all cases of gastric cancer treated during 1970-89.
Setting:
Department of surgery, general hospital.
Subjects:
493 consecutive patients with gastric adenocarcinoma.
Main Outcome Measures:
Operative mortality, postoperative morbidity, and five year survival after radical potentially curative resection.
Results:
207 (42%) patients underwent potentially curative resection. The proportion of all patients in whom this was possible increased significantly (p < 0.01) from 31% in the first five year period to 53% in the last five year period. The proportion of patients who had early gastric cancer rose from 1% to 15% (p < 0.01) and stage I disease rose from 4% to 26% (p < 0.001). After potentially curative resection, mortality 30 days after operation was 6%. Operative mortality decreased from 9% in the 1970s to 5% in the 1980s. Likewise, the incidence of serious postoperative complications decreased from 33% in the 1970s to 17% in the 1980s (p < 0.01). Five year survival was 60% in patients who underwent curative resection, 98% in patients with early gastric cancer, and 93%, 69%, and 28% in stage I, II, and III disease respectively. By the late 1980s five year survival after operation was about 70%.
Conclusions:
These findings suggest that an increasing proportion of patients with gastric cancer could be diagnosed at a relatively early pathological stage when about two thirds are curable by means of radical surgery.