Although the rate of gastric cancer has declined in incidence in many western countries, the disease still ranks high in the list of causes of death for cancer in Italy, where on average 15,000 cases a year were registered in the last decade. During 1986 the Italian Stomach Cancer Group promoted a retrospective project on gastric cancer to which the Departments of Surgery of 26 Italian Hospitals joined. The collected cases consist of 3074 patients who underwent surgery since 1981 to 1985. This series include only patients in follow-up since operation to March 1986 or to death. Out of these cases were considered only 2000 patients affected with gastric carcinoma, grouped following TNM classification, on whom a resective operation had been performed. Of the 2000 patients, 1280 were males and 720 females. The peak of age incidence for both men and women was between 60 and 70 years. The distribution of cases according to the site of the primary lesion in the stomach was also analyzed. In most cases (55%) the lesions were found near the pylorus and the antrum, 25% were in the body of the stomach, 12% were in the cardia and fundus; in 5% of patients the carcinoma involved the whole stomach and in 3% it was a cancer of the gastric stump. Application of TNM stage grouping in these series showed 234 patients (11.7%) in stage I, 494 (24.7%) in stage II, 1011 (50.5%) in stage III, and 261 (13%) in stage IV. Total gastrectomy was carried out in 910 patients (45.5%), while radical subtotal distal resection was performed in 1060 cases (53%); a proximal partial resection was performed only 30 times. The overall postoperative inhospital mortality was 7.1% and resulted lower after distal gastric resection although, in recent years, the mortality rate has declined also after total gastrectomy because of the introduction and wide diffusion of circular staplers and total parenteral nutrition. As to long term results, survival rates are generally inclined to lower by the increasing of the cancer stage: in fact, the 5 year survival rate for stage I was 86%, for stage II 65%, for stage III 28%, for stage IV 10%. Surprisingly 4-5 years after surgery, some patients survive even if classified in stage IV (T4 or N3 or M1) and in whom the operation had been considered not curative. On the contrary no differences in survival rates resulted when different kinds of resection were considered: in particular the survival has not been improved by total gastrectomy in any stage of midgastric and antral cancers.
|Translated title of the contribution||Gastric cancer: A retrospective multicentric study on 3024 operated patients|
|Number of pages||6|
|Publication status||Published - 1990|
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