Prognosis of patients after palliative surgical precedures for carcinoma of the stomach

From 1965 to 1980, 294 (33 per cent) of 885 patients admitted to the Istituto Nazionale Tumori of Milan with carcinoma of the stomach did not undergo a radical operation. Forty-eight patients were not considered suitable for operation due to their poor general status and spread of disease. One hundred and five patients underwent simple exploratory laparotomy, 80 underwent bypass procedure and 61, noncurative resection, and the operative mortality rate was 4.7, 10.0 and 11.5 per cent, respectively. Median survival time was 2.4 months for patients who did not undergo an operation, 2.8 months after exploratory laparotomy and 3.5 months after bypass procedures. Median survival time after nonradical resections was 8.0 months and 6 per cent of these patients survived for more than five years. To perform the analysis within relatively homogeneous groups, patients with different treatment were further stratified into three groups according to the spread of disease: local, distant and local plus distant spread. It is noteworthy that the benefit after bypass procedures in comparison to exploratory laparotomy was limited to those patients with local spread of disease; the advantage of nonradical resection was apparent in all groups. Survival time was finally analyzed with reference to the extent of liver involvement in patients with metastatic disease confined to the liver. The data suggest that a limited sporadic survival time is possible only after gastric resection in patients with liver involvement of less than 50 per cent.