Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma

Background: There are indications that some features of gastric carcinoma a re changing, with a possible impact on prognosis. The aim of this study was to examine any changes in type, location, stage, resection rate, postopera tive mortality rate or prognosis for patients with gastric carcinoma in a w ell defined population. Methods:During 1974-1991, 1161 new cases of gastric adenocarcinoma were dia gnosed in Ostergotland County, Sweden. Tumour location, Lauren histological type, tumour node metastasis (TNM) stage, radicality of tumour resection a nd postoperative complications were recorded after histological re-evaluati on of tissue specimens and examination of all patient records. Dates of dea th were obtained from the Swedish Central Bureau of Statistics, Time trends were studied by comparing the intervals 1974-1982 (period 1) and 1983-1991 (period 2). Results: The proportion of diffuse type of adenocarcinoma increased (from 2 7 to 35 per cent), while that of mixed type decreased (from 16 to 9 per cen t) and that of intestinal type was unchanged. The proportion of tumours loc ated in the proximal two-thirds of the stomach increased (from 32 to 42 per cent) and the proportion of patients with tumours in TNM stage IV decrease d (from 32 to 25 per cent). Overall tumour resection rates were unchanged, although the proportion of radical total gastrectomies increased (from 36 t o 50 per cent). Excluding tumours of the cardia or gastric remnant after pr evious ulcer surgery, the 5-year relative survival rate after radical resec tion increased from 25 to 36 per cent and the postoperative mortality rate decreased for both radical (from 11 to 4 per cent) and palliative (from 18 to 6 per cent) resection. Conclusion: The patterns of tumour histology, location and stage of gastric carcinoma have changed in the authors' region. These changes were parallel ed by a significant improvement in survival and postoperative mortality rat es.