GASTRIC-CANCER - A CURABLE DISEASE IN BRITAIN

Objective-To determine whether more vigorous efforts aimed at earlier diagnosis allied to radical surgical resection lead to improved surviv al of patients with gastric cancer. Design-Prospective audit of all ca ses of gastric cancer treated during 1970-89. Setting-Department of su rgery, general hospital. Subjects-493 consecutive patients with gastri c adenocarcinoma. Main outcome measures-Operative mortality, postopera tive morbidity, and five year survival after radical potentially curat ive resection. Results-207 (42%) patients underwent potentially curati ve resection. The proportion of all patients in whom this was possible increased significantly (p < 0.01) from 31% in the first five year pe riod to 53% in the last five year period. The proportion of patients w ho had early gastric cancer rose from 1% to 15% (p < 0.01) and stage I disease rose from 4% to 26% (p < 0.001). After potentially curative r esection, mortality 30 days after operation was 6%. Operative mortalit y decreased from 9% in the 1970s to 5% in the 1980s. Likewise, the inc idence of serious postoperative complications decreased from 33% in th e 1970s to 17% in the 1980s (p < 0.01). Five year survival was 60% in patients who underwent curative resection, 98% in patients with early gastric cancer, and 93%, 69%, and 28% in stage I, II, and III disease respectively. By the late 1980s five year survival after operation was about 70%. Conclusions-These findings suggest that an increasing prop ortion of patients with gastric cancer could be diagnosed at a relativ ely early pathological stage when about two thirds are curable by mean s of radical surgery.