Surgery: Independent prognostic factor in curable and far advanced gastriccancer

The hospital records of 639 patients affected by primary gastric cancer who were consecutively admitted to our unit during the period 1981-1995 were r eviewed. Overall 220 underwent total gastrectomy (38 palliative), 12 had re section of the gastric stump, 195 had distal subtotal gastrectomy (55 palli ative), 78 had bypass procedures, 72 had explorative laparotomy, and 62 had no operation. Univariate and multivariate analyses were used to evaluate 5 -year survival,vith respect to the main clinical, pathologic, and treatment variables after both curative and palliative treatments. Overall the 5-yea r survival after curative treatment (320 patients-operative mortality exclu ded) was 55.5%: 91.1% for stage IA, 71.5% IB, 62.4% II, 37.5% IIA, 31.5% II IB. Among patients who underwent palliative treatment 5-year survival was 1 3.1% after gastric resection (total or distal subtotal), 4.9% after the byp ass procedures, 0 after explorative laparotomy, and 0 after no operation. U nivariate and multivariate survival analyses showed that variables independ ently associated with poor survival were advanced stage, upper location and D1 lymphadenectomy after curative treatment, tumor spread to distant sites , and nonresectional surgery after palliative treatment. Multivariate analy sis showed that even though survival with gastric cancer depends on predete rmined factors, the type of surgery can have a significant effect on progno sis after both curative and palliative treatment.