March 1989

Gastric AdenocarcinomaA Disease in Transition

Author Affiliations

From the Department of Surgery, New England Deaconess Hospital, Boston (Dr Cady); Departments of General Surgery (Dr Rossi) and Pathology (Dr Silverman), Lahey Clinic Foundation, Burlington, Mass; Department of Thoracic Surgery, Presbyterian–St Luke's Hospital, Chicago (Dr Piccione); and Department of Surgery, Good Samaritan Hospital, Dayton, Ohio (Dr Heck).

Arch Surg. 1989;124(3):303-308. doi:10.1001/archsurg.1989.01410030049009

• 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%.

(Arch Surg 1989;124:303-308)