Gastric adenocarcinoma. A disease in transition
B. Cady, R. L. Rossi, M. L. Silverman, W. Piccione and T. A. Heck
Department of Surgery, New England Deaconess Hospital, Boston, MA.
Two hundred eleven gastric adenocarcinomas diagnosed from 1967 to 1982 were
analyzed. Thirty-four percent had a proximal location, a proportionate
increase from previous decades that suggested a distinctive epidemiology.
Diffuse histology occurred in 49% of cases overall and in 55% of
unresectable cases, which were also increases from previous decades. No
deaths followed curative resections, two (4%) of 50 patients with
palliative resections died, and three (6%) of 54 patients who underwent
exploration without resection died, indicating improved operative
management. Superficial gastric cancer constituted 6% of cases; 91% were
cured. Seventeen percent of cases were linitis plastica and required total
gastrectomy in 77% of resections; only 13% of patients had curative
operations; none were cured. Seventy-nine percent of cases were polypoid or
ulcerated focal cancers. Of operable focal cancers, 72% were resected; 27
(47%) of 57 patients who underwent resection for cure survived five years,
a distinct improvement from previous reports, as was the overall survival
of 21%.
