LONG-TERM SURVIVAL ANALYSIS OF GASTRIC-CANCER LIMITED TO THE SUBSEROSA

Long-term survival following surgery for gastric cancer limited to the subserosa was analyzed. Between 01.01.1984 and 30.06.1995, 265 patien ts were operated for gastric cancer that did not invade beyond the sub serosa. Extended lymphadenectomy was performed in all cases and was co nstant as all patients were operated by only two surgeons. The surviva l outcome was analyzed with particular regard to the exact depth of tu mor infiltration and lymph node involvement. The percentage of patient s with positive lymph nodes increased drastically from 1.7% for mucosa l invasion to 22.7% for submucosal tumor involvement. A further substa ntial increase was observed. from 34.3% for involvement of the muscula ris propria to 66.1% for subserosal involvement, The 10-year tumor spe cific survival rate for turners limited to the mucosa was 100%, for su bmucosa and muscularis propria invasion 79.3% and 72.9% respectively: for subserosal involvement 10-year survival was 54.6%. In multivariate analysis of pathohistological variables only pT- and pN-categories ac cording to the UICC were found to have independent prognostic influenc e on survival. Long-term survival indicates that gastric cancer limite d to the mucosa may well be treated with a less radical approach. Gast ric cancer of the submucosa and muscularis propria both have a similar good long-term prognosis with radical surgery alone whereas cancer of the subserosa probably requires some form of adjuvant therapy.