PREOPERATIVE, INTRAOPERATIVE AND POSTOPERATIVE STAGING OF GASTRIC-CARCINOMA AND CLINICAL OUTCOME

Background. We compared preoperative (combined clinical and radiologic al staging and endoscopical Borrmann classification), intraoperative ( by the surgeon: curative/palliative; R0/R1/R2-resection; intraoperativ e stage I to IV) and postoperative staging including histological resu lts (pTNM) in respect of resectability and prognosis, Methods. All pat ients with adenocarcinoma of the stomach were prospectively and consec utively included in the study protocol and were staged during the hosp italisation by the different specialists, Out of 215 patients with mal ignant tumors of the stomach, 153 were finally evaluated for the study , We excluded 62 patients with other malignancies or with a follow up of less than 6 months, Preoperative endoscopic Borrmann classification was done by the gastroenterologist, preoperative TNM-classification b y the radiologist and surgeon, intraoperative classification by the su rgeon and postoperative classification by the pathologist, All results were immediately described in the protocol, Follow-up and survival cu rves were performed by the Regional Tumor Registry and statistics by t he Statistical Department of the University using Kaplan-Meier surviva l curves and Log-Rank and Wilcoxon Test for significance, Results, Pre operative staging was unreliable and there was no relationship between preoperative and postoperative staging nor survival, In opposite intr a- and postoperative staging correlated significantly between the diff erent groups and with survival (p<0.001). Conclusions, As long as preo perative staging systems are not improved (which may be in the future the case with endosonography), all operable patients with gastric carc inoma should undergo a laparotomy or laparoscopy, because only intraop erative evaluation of the surgeon allows a decision on a possible cura tive resection, Patients with stages I-III should be resected radicall y with complete dissection of lymph node compartments 1 and 2, This po licy is justified especially in view of a minimal hospital mortality ( 3%).