Surgical treatment of gastric cancer. Comparison between periods in a forty-year clinical experience

Surgical treatment of gastric cancer. Comparison between periods in a forty-year clinical experience. Contardo Vergani,MD, FACS Luca Despini,MD, Marco Pagani,MD, and Giancarlo Roviaro MD, FACS Dipartimento di Scienze Chirurgiche, Università degli Studi di Milano – U.O.C. Chirurgia Generale Ospedale Maggiore Policlinico, IRCCS – Milano. Via Francesco Sforza, 35 20122 Milano Italy From 1972 through 2007, 479 patients have been submitted to surgery for gastric cancer at our School. Aim of this paper is to analyse this forty-year experience by comparing two different clinical series collected from 1972 through 1992 and from 1992 through 2207, respectively. The more recent series includes 255 patients (55% older than 65 years), 224 resections with curative intention and 24 palliative procedures. In this series we recorded an 8% complication rate and a 3.5% mortality rate. The previous series, collected between 1972 and 1992, included 240 patients (62% older than 65 years), 209 resections, 11 palliations and 20 exploratory laparotomies. The complication rate was 13% and mortality was 5.4%. The two series have been separately analyzed and then compared in respect of age, operation, T and N descriptors and Stage IA-IB, II. Five-year survival has been calculated by Kaplan Meier method and compared with the log-rank test. The largest series in the literature have been considered and the results compared. In the recent series differences in survival related to age, T and N (N0-N1-N2) descriptors and stage resulted highly significant (p<0.001). Patients younger than 65 have a survival of 56.3% vs. 28.9% of those older than 65. T1 have a survival rate of 83.4% and T2 31.3. N0 patients have 68% survival rate and N1 36.4% and no N2 patient is alive after five years. Stage I five-year survival rate is 67.5% and Stage II survival is 38.1%. No differences in survivalo have been recorded for different types of resection. Among the control series (1972-1992) non significant differences in survival have been found regarding age and type of resection. A significant difference in survival has been found for T (T1 83% vs. T2 57.5%), for N (N0 67%, N1 35%, N2 17%) and for stage (stage I 75% and stage II 34.5%). In the more recent series we found an increased number of cancer in situ and of early stage tumors, with an increased number of partial gastrectomies. Complications have been significantly decreased (8% vs 13%) as did mortality rate (3.5% vs 5.4%) Specific comparison, even though weakened by the relative disomogeneity of the populations considered, shows significant differences in survival for stage but not for different type o f resection. The age is, in the recent series, a highly significant prognostic factor, due to the increased rate of very old patients operated on for gastric cancer. REFERENCES Koovor PA, Hwang J. Treatment of resectable gastric cancer: current standard of care. Expert Rev Anticancer Ther. 2009;9(1):135-42. Ly QP, Sasson AR. Modern Surgical considerations for gastric cancer. J Natl Compr Canc Netw. 2008, 6(8) 885-94. Deng J. Liang H et al- prognosis of gastric cancer patients with node metastasis following curative resection: outcomes of the survival and recurrence. Can J gastroeneterol. 2008;22(10):835-9.