30-YEARS OF GASTRIC-CANCER SURGERY

During the past 30 years, 2,167 cases of gastric carcinoma were resect ed in our hospital. To obtain precise analysis and information, this s eries was simplified by selecting 1,423 curative cases excluding cases with noncurative resection, multiple lesions, insitu carcinoma, EGJ-C a, lesions in the remnant stomach, and synchronous dual malignancies. A remarkable improvement in surgical treatments of gastric carcinoma i ncluded a rate of early carcinoma cases in the curative group that ste adily increased from 8.8% in the first 5 years of our experience betwe en 1961 and 1965 to 64.8% in the last 5 years between 1986 and 1990. S urgical deaths significantly decreased from 2.6% (13/504) in the first decade between 1961 and 1970 to 0.2% (1/464) in the last decade betwe en 1981 and 1990, and the 5-year survival rate increased from 54.8% in the first decade to 83.1% in the last 5 years between 1981 and 1985. Even in a series of advanced transmural lesions, the 5-year survival r ate increased from 63.0% in the first decade to 84.4% in the last 5 ye ars in the negative-node group, and from 32.9% to 56.5% in the positiv e-node group. Early gastric carcinoma series exhibited a 5-year surviv al rate of 96.7% (292/302) with a recurrence rate of 2.6%. A high inci dence of node metastases in 22.4% of patients with a submucosal lesion gives surgeons a sharp warning to carry out careful lymphadenectomy f or such cases.