[Stomach and esophageal neoplasm. Changes over 16 years in clinical materials]

Increasing prevalence of adenocarcinoma of the esophagus and esophago-gastric junction has been reported. The aim of the study was to determine whether this phenomenon is reflected in the cohort of patients referred for surgery to our institution. Clinical and pathological records of patients with adenocarcinoma of the stomach (n = 433) or gastro-esophageal junction (n = 302), and squamous cell carcinoma of the esophagus (n = 266) were reviewed from 1981 to 1996. Yearly prevalence of carcinoma of the gastric cardia in comparison to carcinoma of (a more distal) stomach has not changed, ranging 19-46%. From 1981 to 1984 out of 58 gastric resections, 14 (24%) total gastrectomies were done, whereas from 1993 to 1996 total gastrectomies were performed in 104 out of 138 (75%) patients with gastric cancer (p < 0.001). In the first 4 years of the study period adenocarcinoma of the cardia and/or esophagus was found in 19% of all patients with esophageal and junctional tumors, while in the last 4 years,-in 30%. Resection rates for gastric and cardiac cancers have not changed significantly, 75-100% and 21-65% respectively. Resection rate for carcinoma of the esophagus increased from 50% (17/34) to 79% (53/67) (p = 0.006, test chi2). Increasing rate of total gastrectomies can be explained by a trend towards more proximal localisation of the primary gastric tumors and/or clinical application of Laurén classification for the choice of operative procedure. Higher resection rate for carcinoma of the esophagus is a result of increasing experience of the surgical team, improvement in preoperative staging, new palliative modalities, and application of preoperative chemo-/radiotherapy.