Time trends of surgical treatment and the prognosis for Japanese patients with gastric cancer

The incidence of gastric cancer is much higher in Japan than in other count ries even though diagnostics and treatments of such patients have improved. The objective of this study was to present an overview of the past. presen t and future of surgical treatment for our patients with gastric cancer. We analysed data on 2152 Japanese men and women with gastric cancer who under went surgical resection from 1965 to 1995 at Kyushu University in Fukuoka, Japan, based on a univariate and the multivariate analysis. We focused on t ime trends of surgical treatment and the postoperative outcome. Over the ye ars, there have been favourable changes in the numbers of patients with ear ly gastric cancer, in all cases of gastric cancer; the rate of 18% in the f irst six year period (group 1) was 57% in the last 5 year period (group 6). Size of the tumour was smaller. well-differentiated tumour tissue was more common, and lymphatic involvement was less frequent. Lymph node metastasis , liver metastasis and peritoneal dissemination all decreased. Extensive ly mph node dissection was more frequently done and the rate of curative resec tion (curability A and B) increased. With increases in identifying the earl y stage of cancer and better perioperative care, mortality rates 30 days af ter the surgery greatly decreased. Multivariate analysis revealed that the 10 factors of depth of invasion, lymph node metastasis, lymph node dissecti on, tumour size, liver metastasis, peritoneal dissemination, lymphatic inva sion, Vascular invasion, lesion in the whole stomach and lesion in the midd le stomach were independent factors for determining the prognosis. Detectio n of the tumour in an early stage, standardized surgical treatment, includi ng routine lymph node dissection, close follow-up schedules and better peri operative management are expected to increase survival time for patients wi th this malignancy. (C) 2000 Cancer Research Campaign.