We reviewed 599 patients who underwent gastric cancer surgery during recent 10 years. From May, 1980 to April, 1990 at Department of Surgery, Kangnam St. Mary's Hospital, Catholic University Medical College to document our impression of recent
changes
in aspects of gastric adenocarcinoma including postoperative survival.
Average age was 54 years old with peak incidence of 6th decade(27.5%). No difference was found throughout the study period in average age(53 years old in first half vs 54 years old in second half period).
Although gastric cancer has been prevalent to male(1.7 : 1), the incidence of female patient has been showed increased tendency as 33.3% 30.9%, 38.9%, 37.0% and 41.2% at 2 years interval, respectively.
Epigastric discomfort(60.6%) was the most frequent chief complaint regardless of location but in case of involving upper third, swallowing difficulty and evidence of gastrointestinal bleeding were frequently observed.
Diagnostic accuracy of upper gastrointestinal series and endoscopy was 92.0% and 96.0%, respectively.
Lower third of stomach was the prevalent site of primary tumor(54.9%) while increasing tendency of lesions involving middle third of stomach has been noted.
Borrmann type III was he most common(58.9%) and type II(16.2%), type IV(12.2%) and type I(8.2%) in descending order.
In endoscopic classification of early gastric cancer, type IIc was the most common(61%), type I 13%, type IIa 4%, type IIb 3% and type III 3% in descending order, and combined lesions were 16%.
Overall resectability was 88.8%. Total gastrectomy has been performed more frequently during the second half than the first half period(18.5% vs 14.9%). Overall curative resection rate was 70.6% which has been progressively increased from 56.9%
to
63.3%, 75.2%, 68.5% and 79.1% at 2 years interval, respectively.
By TNM classification, stage I was 14.4% stage II 15.4%, stage III 53.6% and stage IV 16.7%, Overall incidence of early gastric cancer during 10 years was 16.7% and revealed higher incidence during the second half than the first half period(19.1%
vs
12.9%).
Regional lymph node metastasis was found in 66.2% which was well correlated with depth of primary tumor.
Pulmonary complications were the most frequently encountered early postoperative complications, and the others were intestinal obstruction, bleeding from anastomosis, hepatic insufficiency and intraabdominal abscess. Reflux esophagitis and
gastritis
were the most common late complication.
Operative mortality was 1.5%.
The overall 5-year survival rate was 49±2.6%: 86±4.6% of early gastric cancer and 41±2.8% of advanced gastric cancer(p<0.01).
Significant differences of 5-year survival were found according to the surgery performed ;that is, 65±3.1% of curative resection, 11±3.4% of palliative resection while in cases nonresection 14±4.6% of 3-year survival was found without 5-year
survival(p<0.01).
Survival was analysed according to tumor penetration(T), nodal status(N) in 532 cases of resection. Significant differences were found according to tumor penetration: T1(m) 97±2,2%, T1(sm) 81±6.6%, T2 74±7.8%, T3 43±3.6% and T4
19±6.7%(p<0.01).
Similarly, nodal status were well correlated with survival: No 81±4.0%, N1 565.4% n227±4.3% and N3 22±8.9%(p<0.01).
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