INADEQUATE DOCUMENTATION AND RESECTION FOR GASTRIC-CANCER IN THE UNITED-STATES - A PRELIMINARY-REPORT

Patients entered into Southwest Oncology Group gastric adjuvant protoc ol INT 0016 (SWOG 9008) after a ''curative'' gastric resection were as sessed to determine practice patterns of more than 300 surgeons nation wide who performed ''curative'' gastric resections for 453 gastric can cer patients. The most common gastric resection performed was distal i n 256 patients, proximal in 118, and total in 79. Extragastric organs resected were omentum (285), spleen (59), pancreas (18), and bowel (17 ). The extent of lymphadenectomy as staged by Japanese rules was 246 ( 54.2%) DO resections, 173 (38.1%) D1 resections, 28 (6.2%) D2 resectio ns, and 7 (1.5%) D3 resections. Staging of the cancer was poorly docum ented, with no statement made regarding the status of the primary canc er in 6 per cent, liver in 10 per cent, lymph nodes in 17 per cent, an d omentum in 17 per cent. The greater the lymph node clearance, the gr eater the chance of resecting to a level of negative lymphatics, given that 45 per cent of nodes were involved when 10 or less were removed, whereas only 17 per cent were positive when more than 40 were cleared . The lack of adequate clearance of lymph nodes and poor documentation of tumor stage suggests that a more regimented surgical approach to t his uncommon cancer is required.