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. 1993 Nov;218(5):583–592. doi: 10.1097/00000658-199321850-00002

Cancer of the stomach. A patient care study by the American College of Surgeons.

H J Wanebo 1, B J Kennedy 1, J Chmiel 1, G Steele Jr 1, D Winchester 1, R Osteen 1
PMCID: PMC1243028  PMID: 8239772

Abstract

OBJECTIVE. The major purpose of this study was to document the modes of presentation, diagnostic methods, clinical management, and outcome of gastric cancer as reported by tumor registries of US hospitals and cancer programs approved by the American College of Surgeons. SUMMARY BACKGROUND DATA. Gastric cancer continues to diminish in the US, but the stage of disease and survival outcome after surgical resection is unchanged despite increased availability and sophistication of diagnostic techniques. This is in contrast to the marked improvement in survival outcome in Japanese and other Eastern series over the last decades. Possible reasons for the improved Japanese results have been earlier detection secondary to active diagnostic surveillance of the population and widespread adoption of aggressive surgical resection emphasizing wide-field node (R2) dissection. Although selected US centers using the Japanese approach report better survival data, the approach has not been widely adapted by US treatment centers. METHODS. Tumor registries at American College of Surgeons (ACS) approved hospitals were mailed a study protocol in 1987. They were instructed to review 25 consecutive patients with gastric cancer treated in 1982 (long-term study) and 25 patients treated in 1987 (short-term study). A detailed protocol included significant history, diagnostic results, staging, pathology findings, and treatment results. The data forms on 18,365 patients were returned and analyzed (11,264 patients in the long-term study and 7101 patients in the short-term study). RESULTS. Of 18,365 patients, 63% were males. The median ages were 68.4 years in males and 71.9 years in females. There was a history of gastric ulcer in 25.5% of the patients. Lesion location was upper third in 31%, middle third in 14%, distal third in 26%, and entire stomach in 10% of patients (and the site was unknown in 19%). Gastric resection was performed for 80% of upper third cancers and 85% of distal third cancers; 50% of patients with total gastric involvement had gastric resection. The extent of gastric resection varied according to location. For lower third lesions, subtotal gastrectomy was done in 55% of the cases, extended resection in 21%, and total gastrectomy in 6%. For proximal lesions, 29% had subtotal, 4.6% had total, and 41% had extended gastrectomies (including esophagus), and 13.6% had dissection of celiac nodes. The operative mortality rate was 7.2%. Staging (American Joint Committee on Cancer [AJCC]) was as follows: I, 17%; II, 17%; III, 36%; and IV, 31%. The overall survival rate reflecting deaths from all causes was 14% among 10,891 patients diagnosed in 1982, and it was 19% in patients having resection. The disease specific survival rate was 26%. The survival rate after resection was 19% and 21% for lower and mid third cancers, 10% for upper third cancers, and 4% if the entire stomach was involved. The stage-related survival rates were 50% (stage I), 29% (stage II), 13% (stage III), and 3% (stage IV). Among patients with pathologically clear margins, the survival rate was 35% versus 13% in those with microscopically involved margins, and it was 3% in those with grossly involved margins. CONCLUSION. This report of gastric cancer treatment by American College of Surgeons approved institutions in the US provides an overview of the disease as commonly treated throughout the US. Although the results are less favorable than those reported by centers with large institutional experiences with this disease and are inferior to those of the Japanese and other Eastern centers, they suggest potential for increasing survival by upstaging through earlier diagnosis and using resectional techniques demonstrated to more adequately control local regional disease.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adashek K., Sanger J., Longmire W. P., Jr Cancer of the stomach. Review of consecutive ten year intervals. Ann Surg. 1979 Jan;189(1):6–10. doi: 10.1097/00000658-197901000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Adkins R. B., Jr, DeLozier J. B., 3rd, Scott H. W., Jr, Sawyers J. L. The management of gastric ulcers. A current review. Ann Surg. 1985 Jun;201(6):741–751. doi: 10.1097/00000658-198506000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Correa P. Clinical implications of recent developments in gastric cancer pathology and epidemiology. Semin Oncol. 1985 Mar;12(1):2–10. [PubMed] [Google Scholar]
  4. Dupont J. B., Jr, Lee J. R., Burton G. R., Cohn I., Jr Adenocarcinoma of the stomach: review of 1,497 cases. Cancer. 1978 Mar;41(3):941–947. doi: 10.1002/1097-0142(197803)41:3<941::aid-cncr2820410323>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
  5. Gunderson L. L., Sosin H. Adenocarcinoma of the stomach: areas of failure in a re-operation series (second or symptomatic look) clinicopathologic correlation and implications for adjuvant therapy. Int J Radiat Oncol Biol Phys. 1982 Jan;8(1):1–11. doi: 10.1016/0360-3016(82)90377-7. [DOI] [PubMed] [Google Scholar]
  6. Kennedy B. J. T N M classification for stomach cancer. Cancer. 1970 Nov;26(5):971–983. doi: 10.1002/1097-0142(197011)26:5<971::aid-cncr2820260503>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
  7. LARSON N. E., CAIN J. C., BARTHOLOMEW L. G. Prognosis of the medically treated small gastric ulcer. I. Comparison of follow-up data in two series. N Engl J Med. 1961 Jan 19;264:119–123. doi: 10.1056/NEJM196101192640304. [DOI] [PubMed] [Google Scholar]
  8. LAUREN P. THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION. Acta Pathol Microbiol Scand. 1965;64:31–49. doi: 10.1111/apm.1965.64.1.31. [DOI] [PubMed] [Google Scholar]
  9. LaDUE J. S., MURISON P. J. Symptomatology and diagnosis of gastric cancer. Arch Surg. 1950 Feb;60(2):305–335. doi: 10.1001/archsurg.1950.01250010323010. [DOI] [PubMed] [Google Scholar]
  10. Maruyama K., Okabayashi K., Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987 Aug;11(4):418–425. doi: 10.1007/BF01655804. [DOI] [PubMed] [Google Scholar]
  11. Nicholls J. C. Stump cancer following gastric surgery. World J Surg. 1979 Nov;3(6):731–736. doi: 10.1007/BF01654802. [DOI] [PubMed] [Google Scholar]
  12. Papachristou D. N., Fortner J. G. Local recurrence of gastric adenocarcinomas after gastrectomy. J Surg Oncol. 1981;18(1):47–53. doi: 10.1002/jso.2930180108. [DOI] [PubMed] [Google Scholar]
  13. Scott H. W., Jr, Adkins R. B., Jr, Sawyers J. L. Results of an aggressive surgical approach to gastric carcinoma during a twenty-three-year period. Surgery. 1985 Jan;97(1):55–59. [PubMed] [Google Scholar]
  14. Shiu M. H., Moore E., Sanders M., Huvos A., Freedman B., Goodbold J., Chaiyaphruk S., Wesdorp R., Brennan M. F. Influence of the extent of resection on survival after curative treatment of gastric carcinoma. A retrospective multivariate analysis. Arch Surg. 1987 Nov;122(11):1347–1351. doi: 10.1001/archsurg.1987.01400230135024. [DOI] [PubMed] [Google Scholar]
  15. Stalsberg H., Taksdal S. Stomach cancer following gastric surgery for benign conditions. Lancet. 1971 Nov 27;2(7735):1175–1177. doi: 10.1016/s0140-6736(71)90489-2. [DOI] [PubMed] [Google Scholar]
  16. Toftgaard C. Gastric cancer after peptic ulcer surgery. A historic prospective cohort investigation. Ann Surg. 1989 Aug;210(2):159–164. doi: 10.1097/00000658-198908000-00004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Yan C. J., Brooks J. R. Surgical management of gastric adenocarcinoma. Am J Surg. 1985 Jun;149(6):771–774. doi: 10.1016/s0002-9610(85)80183-5. [DOI] [PubMed] [Google Scholar]

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