SURVIVAL AFTER RESECTION OF GASTRIC-CANCER AND PROGNOSTIC RELEVANCE OF SYSTEMATIC LYMPH-NODE DISSECTION - 20 YEARS EXPERIENCE IN TAIWAN

A retrospective study of 954 resectable gastric cancers in a single in stitute of Taiwan from 1971 to 1990 was performed to evaluate improvem ents In gastric cancer surgery. The patients were divided into four ti me periods representing an overall experience of progressive implement ation of aggressive resection and increased extent of systematic lymph node dissection. The clinicopathologic data and survival rates were s tatistically compared and the significance of the extent of resection on survival analyzed. A significant increase in the proportion of uppe r one-third tumors (from 14.8% to 20.4%) and a decrease in the inciden ce of intestinal type (73.6% to 41.5%) was found within the overall pe riod. The proportion of patients with early gastric cancer increased f rom 11.5% to 19.4%. Patients who underwent total gastrectomy and combi ned visceral resection increased from 13.7% to 27.4% and 19.8% to 41.1 %, respectively. An increase of both total dissected lymph node number and the incidence of detected lymph node metastases in early gastric cancer were associated with more extensive lymphadenectomy. An improve d 5-year survival rate following aggressive resection was found for al l stages except stage IV and T4 lesions, and the surgical mortality de creased from 5.5% to 2.0%. Patients with earlier stage lesions benefit ed more from radical resection, especially those with stage II and T2 lesions. Systematic lymph node dissection increased the 5-year surviva l of patients by about 10% for stage III or T3 lesions but not for pat ients with stage IV or T4 lesions. Multivariate analysis confirmed the significance of the improved technique of lymphadenectomy on the prog nosis of gastric cancer following resection in Taiwan. In conclusion, a changing pattern of gastric cancer epidemiology in Taiwan is documen ted. A decrease in surgical mortality indicates that curative resectio n with extensive lymph node dissection can be safely performed. Althou gh potential for increasing survival by upstaging remains, radical gas trectomy with extended lymphadenectomy could be adopted for gastric ca ncer resection with possibly more adequate control of locoregional dis ease.