A SELECTIVE THERAPEUTIC APPROACH TO GASTRIC-CANCER IN A LARGE PUBLIC HOSPITAL

BACKGROUND: Gastric cancer is a common malignancy with a poor prognosi s. The improved survival reported from Japan may be due to earlier det ection or to more radical surgery, or both. The relevance of their met hods to gastric cancer seen in Western countries is uncertain. PATIENT S AND METHODS: The study involved 204 patients with gastric carcinoma. Preoperative staging by computed tomography scan and endoscopic ultra sound showed that 120 patients (59%) had stage IV disease. RESULTS: Cu rative resection was performed in 66 patients, palliative resection in 32, bypass/intubation in 39, chemotherapy alone in 41, and supportive treatment in 26. Neoadjuvant chemotherapy was given to 40 of 66 patie nts treated with curative resection. The mortality of gastrectomy was 3%. Survival was significantly improved after curative resection compa red with palliative resection, which in turn was improved over non-res ectional or nonsurgical therapy. Postoperative morbidity included four intra-abdominal abscesses, all associated with splenectomy. CONCLUSIO NS: Curative surgery for gastric cancer is worthwhile, but the advance d stage of the disease in a public hospital should encourage the estab lishment of a screening program in high risk populations.