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Kim DY, Joo JK, Park YK, Ryu SY, Kim YJ, Kim SK, Lee JH. Is palliative resection necessary for gastric carcinoma patients? Langenbecks Arch Surg 2007; 393:31-5. [PMID: 17593384 DOI: 10.1007/s00423-007-0206-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2007] [Accepted: 06/01/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The benefit of palliative resection for gastric carcinoma patients remains controversial. We thus evaluated the survival benefit of palliative resection in advanced gastric carcinoma patients. MATERIALS AND METHODS We reviewed the hospital records of 466 gastric carcinoma patients who had palliative resection and compared the clinicopathologic findings to those of patients who underwent a bypass or exploration from 1986 to 2000. RESULTS Cox's proportional hazard regression model revealed only one independent statistically significant prognostic parameter, the presence of peritoneal dissemination (risk ratio, 0.739; 95% confidence interval, 0.564-0.967; P < 0.05). The 5-year survival rate of patients who had palliative resection was higher than that of patients who did not (7.03 vs 0%, P < 0.001). When the 5-year survival rates of patients with peritoneal dissemination were examined, the rate was higher for those who underwent resection (4.43 vs 0%, P < 0.001). CONCLUSION The results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.
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Affiliation(s)
- Dong Yi Kim
- Division of Gastroenterologic Surgery, Department of Surgery, Chonnam National University Medical School, 8, Hakdong, Dongku, Gwangju 501-757, South Korea.
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Vohra LS, Subhas P, Rajagopal G, Mukhopadhyay HG. ADENOCARCINOMA STOMACH A REVIEW OF 168 CASES. Med J Armed Forces India 1994; 50:89-91. [PMID: 28769175 PMCID: PMC5529689 DOI: 10.1016/s0377-1237(17)31005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Medical records of 168 patients with gastric adenocarcinoma treated at Malignant Diseases Treatment Centre, Command Hospital (SC) Pune over a ten year period were analysed. Laparotomy was performed in 146 patients; in 82 patients a gastric resection was done, palliative gastrojejunostomy was done in 42 patients, while in 22 patients only a diagnostic biopsy was done. The resection was considered to be curative in 21 patients. Overall operative mortality was 12.3%. According to the international TNM Classification 16% patients were in Stage I, 13.7% in Stage II, 34.3% in Stage III and 35.8% in Stage IV. A significant correlation was found between five year survival rate and overall stage of disease as well as regional lymph node involvement (p < 0.001). Significantly better survival rates were seen in those who had curative resection as opposed to palliative resection (p < 0.01). Overall survival rate at five years in our patients was 8.3% this poor outcome was probably related to the advanced stage of disease at presentation.
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Affiliation(s)
- L S Vohra
- Classified Specialist (Surgery and Oncology), Command Hospital (EC), Calcutta-700 027
| | - P Subhas
- Senior Adviser (Surgery and Oncology), Army Hospital, Delhi Cantt-110 010
| | - G Rajagopal
- Classified Specialist, (Surgery and Oncology), Command Hospital (SC), Pune-411 040
| | - H G Mukhopadhyay
- Senior Adviser; (Surgery and Oncology), Command Hospital (SC), Pune-411 040
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Sue-Ling HM, Johnston D, Martin IG, Dixon MF, Lansdown MR, McMahon MJ, Axon AT. Gastric cancer: a curable disease in Britain. BMJ (CLINICAL RESEARCH ED.) 1993; 307:591-6. [PMID: 8401015 PMCID: PMC1678908 DOI: 10.1136/bmj.307.6904.591] [Citation(s) in RCA: 179] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine whether more vigorous efforts aimed at earlier diagnosis allied to radical surgical resection lead to improved survival of patients with gastric cancer. DESIGN Prospective audit of all cases of gastric cancer treated during 1970-89. SETTING Department of surgery, general hospital. SUBJECTS 493 consecutive patients with gastric adenocarcinoma. MAIN OUTCOME MEASURES Operative mortality, postoperative morbidity, and five year survival after radical potentially curative resection. RESULTS 207 (42%) patients underwent potentially curative resection. The proportion of all patients in whom this was possible increased significantly (p < 0.01) from 31% in the first five year period to 53% in the last five year period. The proportion of patients who had early gastric cancer rose from 1% to 15% (p < 0.01) and stage I disease rose from 4% to 26% (p < 0.001). After potentially curative resection, mortality 30 days after operation was 6%. Operative mortality decreased from 9% in the 1970s to 5% in the 1980s. Likewise, the incidence of serious postoperative complications decreased from 33% in the 1970s to 17% in the 1980s (p < 0.01). Five year survival was 60% in patients who underwent curative resection, 98% in patients with early gastric cancer, and 93%, 69%, and 28% in stage I, II, and III disease respectively. By the late 1980s five year survival after operation was about 70%. CONCLUSIONS These findings suggest that an increasing proportion of patients with gastric cancer could be diagnosed at a relatively early pathological stage when about two thirds are curable by means of radical surgery.
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Affiliation(s)
- H M Sue-Ling
- Academic Unit of Surgery, Centre for Digestive Diseases, General Infirmary, Leeds
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Sue-Ling HM, Martin I, Griffith J, Ward DC, Quirke P, Dixon MF, Axon AT, McMahon MJ, Johnston D. Early gastric cancer: 46 cases treated in one surgical department. Gut 1992; 33:1318-22. [PMID: 1446852 PMCID: PMC1379596 DOI: 10.1136/gut.33.10.1318] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Forty six consecutive patients with early gastric cancer were treated between 1970 and 1990. The proportion of cases of early gastric cancer increased significantly (p < 0.01) from 1% of all cases in the first five year period to 15% in the last five year period, because of greater awareness of the condition and more widespread use of endoscopy. There were 33 men and 13 women, of median age 69 years (range 38-86). Most patients (91%) presented with symptoms indistinguishable from those of peptic ulceration. The median duration of symptoms was four months (range 0.1-36 months). All 46 patients were treated surgically. Three patients (6.5%) died after operation and a further 10 (22%) suffered postoperative complications. None of the surviving patients has been lost to follow up and 25 have been followed up for a minimum period of five years. Five year survival by life table analysis was 98%. These findings suggest that in Britain in the 1990s, as in Japan, it may be possible to diagnose an increasing proportion of patients with gastric cancer at a relatively early pathological stage, when most patients can be cured by radical surgical resection with lymphadenectomy.
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Affiliation(s)
- H M Sue-Ling
- University Department of Surgery, General Infirmary, Leeds
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5
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Akoh JA, Macintyre IM. Improving survival in gastric cancer: review of 5-year survival rates in English language publications from 1970. Br J Surg 1992; 79:293-9. [PMID: 1576492 DOI: 10.1002/bjs.1800790404] [Citation(s) in RCA: 146] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this review of English language publications from 1970, 5-year survival rates after surgery for gastric cancer have been analysed. While the proportion of patients coming to operation has fallen from 92 per cent before 1970 to 71 per cent by 1990, the proportion of operated patients undergoing resection has increased from 37 per cent before 1970 to 48 per cent before 1990. This change suggests improved preoperative staging leading to better patient selection for operation. The 5-year survival rate following all resections has increased significantly from 20.7 per cent before 1970 to 28.4 per cent before 1990, an increase of 7.7 per cent (95 per cent confidence interval 7.1-8.3 per cent). The 5-year survival rate following curative or radical resection has risen from 37.6 to 55.4 per cent over the same period, an increase of 17.8 per cent (95 per cent confidence interval 17.1-18.5 per cent). It is likely that this improvement has contributed to the decrease in the mortality rate from gastric cancer. Comparison of Japanese series with others suggests that diagnosis and treatment of the disease at an earlier stage will result in an even greater increase in 5-year survival rates outside Japan. Of the papers studied, 56 per cent were excluded from analysis, the majority because the data provided about 5-year survival rates were insufficient or the survival calculations inappropriate. Results of survival after operations for gastric cancer should be calculated and presented in a standardized manner.
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Affiliation(s)
- J A Akoh
- Western General Hospital, Edinburgh, UK
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Macintyre IM, Akoh JA. Improving survival in gastric cancer: review of operative mortality in English language publications from 1970. Br J Surg 1991; 78:771-6. [PMID: 1873699 DOI: 10.1002/bjs.1800780703] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In this review of English language publications from 1970, operative mortality following surgery for gastric cancer has been analysed. Operative mortality has declined in series reporting operations in successive decades to 1970, 1980 and 1990. Series reporting patients having surgery for gastric cancer in the decade to 1990 show a mean operative mortality rate of 7.8 per cent (median 4.6 per cent). This improvement may have contributed to the declining mortality rates for gastric cancer in the face of unchanging surgical workload. Results of operations for gastric cancer should be reported in a standard manner.
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Carmalt HL, Gillett DJ, Lin BP. Early gastric cancer. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1990; 60:865-9. [PMID: 2241645 DOI: 10.1111/j.1445-2197.1990.tb07490.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eighteen cases of 'early gastric cancer' have been managed over a 14-year period. This represents only 3.5% of all patients diagnosed as having adenocarcinoma of the stomach. The symptoms of early gastric cancer are similar to those of benign peptic ulcer disease and differ from those of invasive disease. The pathology of the lesions is described and the morphology shown to be similar to that seen in Japan. The overall 5-year survival rate is 82% but no patient has developed recurrence within 5 years of surgery, confirming the biological behaviour of the lesion to be identical to that noted by Japanese researchers.
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Affiliation(s)
- H L Carmalt
- Department of Surgery, Repatriation General Hospital, Concord, New South Wales
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Carmalt HL, Gillett DJ, Hollinshead JW. Carcinoma of the stomach: a review with special reference to total gastrectomy. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1990; 60:759-63. [PMID: 1698355 DOI: 10.1111/j.1445-2197.1990.tb07470.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Five hundred and eleven patients with adenocarcinoma of the stomach were reviewed. Weight loss and abdominal pain were the most common symptoms. One-third of patients were found to have proximal gastric lesions with dysphagia being a major symptom in 23% of all patients. Laparotomy was performed on 88% of patients with 56% of the entire series undergoing gastric resection. The overall 5-year survival rate was 12.3% and for curative resection 43%. The 5-year survival rate of patients undergoing total gastrectomy was 53% and for patients undergoing subtotal or partial gastrectomy the 5-year survival rate was 42%. The operative mortality, similar in both groups, was 8.1% versus 5.6%. Palliation was better achieved by resection than bypass. Total gastrectomy for palliation was undertaken in 48 patients. This group of patients has achieved a good quality of life and a mean survival rate of 12.5 months.
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Affiliation(s)
- H L Carmalt
- Department of Surgery, Repatriation General Hospital, Concord, New South Wales
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Breaux JR, Bringaze W, Chappuis C, Cohn I. Adenocarcinoma of the stomach: a review of 35 years and 1,710 cases. World J Surg 1990; 14:580-6. [PMID: 2238656 DOI: 10.1007/bf01658794] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The records of 1,710 patients with adenocarcinoma of the stomach treated at Charity Hospital over a 35-year period were reviewed to note any trends which might help in understanding the decreasing incidence and poor prognosis of the disease. The yearly number of gastric cancer patients has dropped from 234/100,000 in the 1950's to 195/100,000 in the 1960's to 108/100,000 patients in the last decade. The percentage of affected white males is decreasing at a rate equal to the increasing frequency of black female patients, while the ratios for black males and white females remain constant. The median age rose from 61.5 years to 66 years over the study period. The operability rate decreased from 82.4% to 72.8% and the resectability rate was 49%. Subtotal gastrectomy was the most common procedure, but radical subtotal gastrectomy gave the best 5-year survival. There are fewer lesions of the antrum today, but the highest number of 5-year survivors had antral lesions. Long-term survival of patients with lesions of the cardia improved from zero in the first 25 years to 14% in the last decade. For the last 2 decades, patients with stage III and IV lesions comprised one-half of the 5-year survivors. Our overall 5-year survival was 7.9%, but in the last decade it was 8.9%. Our 5-year survival for all patients who underwent a resection was 17.9%, but increased to 24.8% for the last decade. These improvements, in combination with a decrease in incidence, have dropped the overall mortality from gastric cancer.
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Affiliation(s)
- J R Breaux
- Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112-2822
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Msika S, Chastang C, Houry S, Lacaine F, Huguier M. Lymph node involvement as the only prognostic factor in curative resected gastric carcinoma: a multivariate analysis. World J Surg 1989; 13:118-23; discussion 123. [PMID: 2471364 DOI: 10.1007/bf01671171] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The aim of this study was to evaluate the independent influence of clinical and pathological variables on survival of patients with gastric carcinoma using the Cox regression proportional hazard model. Of 156 patients operated on for gastric carcinoma, 46 (29.5%) underwent palliative operation, 24 (15.5%) had a palliative resection, and 86 (55%) had a curative resection. The overall 5-year survival rate was 25 +/- 4%. After curative resection, the 5-year survival rate was 44 +/- 6%. Univariate analysis applied to these patients showed that poor survival was related (p less than 0.01) to: age (over 80 years), absence of epigastric pain, vomiting and dysphagia, total gastrectomy, tumor size (more than 4 cm), lymph node involvement (LNI), invasion through the muscularis propria, absence of intestinal metaplasia near the tumor, and linitis plastica. In multivariate analysis, lymph node involvement was found to be the only independent prognostic factor. The 5-year survival rate was 75.5 +/- 8% without LNI, 28 +/- 10% with proximal LNI, and 7 +/- 6% with distal LNI. Our results suggest that classification into 3 LNI groups is the best staging system for curative resection in gastric carcinoma.
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11
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White H, Parker MC. Follow-up of Surgical Cancer Patients. Surg Oncol 1989. [DOI: 10.1007/978-3-642-72646-0_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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12
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Abstract
A variety of malignancies may arise from the stomach, but the vast majority are adenocarcinomas. Despite a steady decline in the incidence of gastric carcinomas in the United States over the last 50 years, the overall prognosis remains dismal. Early diagnosis and an aggressive surgical approach provide the best hope of improving the outlook for patients with gastric cancer.
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Abstract
Gastric carcinoma, the commonest cause of death from malignant disease in Trinidad, has decreased steadily over the period 1968-1977. Of the 1052 deaths during this time, females accounted for a relatively high percentage (45%) of cases. There is a predominance of antral tumors, and most cases present with very advanced disease (88% with Stage III & IV). This results in a low resectability rate (32%). Its racial predilection for blacks of the lower income group suggests that both genetic and environmental factors may be important. The possible role of dietary factors is discussed.
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14
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Dehn TC, Reznek RH, Nockler IB, White FE. The pre-operative assessment of advanced gastric cancer by computed tomography. Br J Surg 1984; 71:413-7. [PMID: 6722474 DOI: 10.1002/bjs.1800710603] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Forty-five patients with proven gastric adenocarcinoma underwent pre-operative abdominal computed tomography (CT). The radiological findings of tumour spread were prospectively compared with the surgical findings obtained at laparotomy. CT evidence of involvement of three organs, together with the presence of a large gastric tumour mass, correlated with the inability to resect the tumour in this series.
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Abstract
Fifty-one of 256 patients underwent a palliative procedure for advanced carcinoma of the stomach (TNM stage IV). The resection was classified as palliative if metastatic disease was left behind in the lymph nodes, if involvement of organs elsewhere in the abdominal cavity was present, or if microscopy revealed tumor tissue in the resection lines. Twenty-six patients underwent a resection for palliation. There were 14 total and 12 partial gastrectomies. There were 2 deaths after total gastrectomy because of anastomotic leakage. The mean survival time after operation was 9.5 months. In 13 patients (50%) palliation was good with preoperative symptomatic relief without initiating new symptoms, acceptable body weight, and solid food intake. In 7 patients (27%) palliation was moderate, and in 4 (15%) poor. The results after gastroenterostomy in 25 patients were poor. The study shows that palliative total and partial gastrectomy can produce palliation in advanced gastric cancer.
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Yap P, Pantangco E, Yap A, Yap R. Surgical management of gastric carcinoma. Follow-up results in 465 consecutive cases. Am J Surg 1982; 143:284-7. [PMID: 7065345 DOI: 10.1016/0002-9610(82)90091-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A retrospective study was made of a consecutive series of 465 patients with histologically proven gastric carcinoma operated on from December 1950 to December 1974. There were 352 men and 113 women, for a male-female ratio of 3.1 to 1. The peak age of incidence was 51 to 55 years. Noncurative surgical procedures were performed in 49.5 percent with no 5 year survivors; 50.5 percent had curative gastric resection. The ulcerating type was the most common lesion, and the pylorus and antrum were the most common primary sites of tumor. Applying the TNM pathologic stage grouping, the study revealed that 3.4 percent of the patients with curative resections were in stage I, 25.5 percent were in stage II and 71 percent in stage III. The 5 year survival rate was 100 percent for stage I, 70 percent for stage II and 20 percent for stage III. Eighty-four patients or 35.7 percent of those with curative gastric resection survived 5 years or longer. The operative mortality was 3.5 percent for the group with noncurative surgical procedures and 2.1 percent for the group with curative gastric resections, giving an overall operative mortality of 2.8 percent for the entire series.
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Abstract
Review of 298 cases of primary gastric malignancy from 1958 to 1978 revealed 265 cases of adenocarcinoma. Overall 5-year survival rate was a disappointing 5.5%, which was less than the earlier series of Oschner Clinic (7.5%). Curative resections produced a five-year survival rate of 26%. Patients presented with advanced disease; 84% had Stage III or IV disease at time of initial observation. The introduction of fiberoptic endoscopy during this period greatly enhanced the accuracy of preoperative diagnosis of tissue-proven cancer from 6% before fiberoptic to 58% since. Worldwide experience is much better, with overall five-year survival rate of 17.9%. Excellent survival statistics from Japanese studies reflect both the effects of mass surveying and early surgery and the prevalence of superficial spreading type of cancer. Improvement of results in this country will require more aggressive evaluation and earlier surgical intervention.
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Koga S, Kishimoto H, Tanaka K, Miyano Y, Kawaguchi H, Takeda R, Nishidoi H, Kimura O. Results of total gastrectomy for gastric cancer. Am J Surg 1980; 140:636-8. [PMID: 7435822 DOI: 10.1016/0002-9610(80)90046-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To compare the results of total gastrectomy performed during the last 30 years, we classified 256 patients into four chronologic groups. Despite advances facilitating early detection of gastric cancer, the percentage of patients with stage IV cancer was not significantly different among the four groups. However, operative mortality decreased and curability increased in the two most recent groups. The 5 year survival rate was significantly increased in patients operated on after 1960. Our results show that in Japan, operative mortality and 5 year survival compare favorably with reports from Western countries.
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Hecker R, Durbridge T. Carcinoma of the stomach--prognostic factors and current treatment. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1980; 10:309-14. [PMID: 6931569 DOI: 10.1111/j.1445-5994.1980.tb04076.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Two-hundred-and-six cases of gastric carcinoma were analysed for survival on the basis of their clinical, endoscopic and operative findings. An attempt has been made to identify prognostic factors and the role of edoscopy. It is concluded that too much radical surgery is being performed in patients who can be recognised preoperatively as having obviously advanced disease.
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Elmes CR, Harris O, Fielding G, Windsor C. GASTRIC CARCINOMA IN BRISBANE. Med J Aust 1979. [DOI: 10.5694/j.1326-5377.1979.tb134489.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chris R. Elmes
- Gastro‐Oesophageal ProjectPrincess Alexandra HospitalBrisbane
| | - Owen Harris
- Gastro‐Oesophageal ProjectPrincess Alexandra HospitalBrisbane
| | - George Fielding
- Gastro‐Oesophageal ProjectPrincess Alexandra HospitalBrisbane
| | - Clement Windsor
- Gastro‐Oesophageal ProjectPrincess Alexandra HospitalBrisbane
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Gilbert JM, Cassell P, Ellis H, Wastell C, Hermon-Taylor J, Hellman K. Adjuvant treatment with razoxane (ICRF 159) following resection of cancer of the stomach. Recent Results Cancer Res 1979; 68:217-21. [PMID: 752859 DOI: 10.1007/978-3-642-81332-0_33] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
The records of 1,497 patients with histologically proven adenocarcinoma of the stomach were reviewed from Charity Hospital over the 25-year period, 1948 to 1973. The operability rate was 82% and the resectability rate was 48%. In this series gastric carcinoma predominated in males and Negroes. Necropsy studies indicate a similar frequency of involvement of various organs in patients not operated upon as well as those subjected to a prior operation, which suggests the need for some therapeutic endeavors aimed at a wider base than the primary organ. The five-year survival rate, 7.4 overall, varied from 2.0% after esophagogastrectomy to 22.1% after radical subtotal gastrectomy, and to 30.3% for those with localized disease. One hundred one patients survived five years or more, and 5.4% survived ten years or more after the diagnosis of gastric cancer. Radical subtotal gastrectomy gave the best results in this series, whether measured in terms of median survival, five-year survival, or operative mortality. Esophagogastrectomy and by-pass procedures had high mortality and low survival rates, and should be reserved for special conditions.
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