Gastric carcinoma. A ten-year review

• Published in: Annals of surgery Vol. 198; no. 1; pp. 9 - 12
• Main Authors: Diehl, J T, Hermann, R E, Cooperman, A M, Hoerr, S O
• Format: Journal Article
• Language: English
• Published: United States 01.07.1983
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - mortality; Duodenoscopy; Esophagoscopy; Gastroscopy; Humans; Laparotomy; Lymphatic Metastasis; Neoplasm Staging; Prognosis; Stomach Neoplasms - diagnosis; Stomach Neoplasms - mortality; Time Factors
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-198307000-00003

Data on 164 patients treated at the Cleveland Clinic with gastric adenocarcinoma during the ten year period 1970 to 1980 was analyzed. Fiberoptic esophagogastroduodenoscopy was introduced as a routine diagnostic modality during this time and yielded a positive tissue diagnosis in 86% of patients in this series. Laparotomy was performed on 150 patients; 49 patients (30%) were biopsied only, 19 (12%) were bypassed for palliation, and 82 (58%) underwent gastrectomy. Of the latter group, only 45 patients (27%) were resected for cure. The overall operative mortality rate was 6%. All patients were staged according to the International TNM classification (stage I--10%, II--24%, III--12%, and IV--53%). Survival at 5 years was influenced by tumor location and extent of gastric resection but was most significantly related to stage of disease at operation (stage I--65%, II--22%, III--5%, and IV--0%; p less than 0.0001) and to the status of regional nodes (positive--17%, negative--56%; p less than 0.005). Despite the routine use of fiberoptic endoscopy, the majority of gastric cancers were advanced at diagnosis and their prognosis remains discouraging. Improvement of results will require a more aggressive approach to the endoscopic investigation of upper gastrointestinal symptoms and earlier surgical intervention.