Gastric cancer: surgical management and prognosis

The experience of the Department of Surgery of Oulu University Hospital, Finland, in the treatment of 203 consecutive patients (129 men and 74 women, mean age 64.9 years) with primary gastric cancer during the five-year period from 1983 to 1987 is reviewed. 196 (96.6%) patients underwent surgery; radical gastrectomy with limited lymphadenectomy in 88 (43.3%) cases, palliative gastric resections in 47 (23.3%) cases and symptomatic bypass procedures in 27 (13.3%) cases. Postoperative complications occurred more frequently after total than after subtotal gastrectomy. Overall postoperative mortality was 9.2%. The five-year survival was 21.1% for all patients and 45.5% for curatively operated patients. Univariate analysis indicated that tumour size, location, gross appearance, degree of gastric wall invasion, presence of lymph node and/or distant metastases, and operative procedures were the significant prognostic factors of survival. In a Cox multivariate analysis on the T stage and presence of distal metastases independently affected survival. Our results show that besides early detection, the standardisation of surgical procedures (extent of gastrectomy and lymphadenectomy) as well as substantial decrease in postoperative complications and mortality rates are of importance in the improvement of the outcome of surgery for gastric cancer.