Adenocarcinoma of the stomach. Chronologic changes of the surgical management in a series of 350 patients

Study aim: The aim of this prospective study was to evaluate, in a series o f 350 gastric adenocarcinomas, the evolution of their clinical and histolog ical features and the evolution of their surgical management. Patients and methods: From 1970 to 1996, 350 patients with gastric carcinom a (cardiac cancer excluded) were operated on in the same center. Mean age w as 68.8 years and the sex ratio 1:4. These patients were divided into three groups which were analysed and compared (group 1 operated on between 1970 and 1988, group 2 between 1979 and 1987, group 3 between 1988 and 1996). Results: Antropyloric cancer was the most common (56% in group 3). Tumor si ze decreased but there were in group 3 more undifferentiated tumors (54.2%) and more tumors with lymph node involvement (72%). Stage III and IV tumors were still common (70% in group 3) and early gastric cancer incidence very low (9.9%). After 1980, surgical management was more radical, with more to tal gastrectomies and larger lymph node dissections. Adjuvant intraoperativ e and postoperative radiotherapy has been associated since 1985. Postoperat ive mortality rate decreased (13.8% in group 1 vs 6.1% in group 3) (P = 0.0 4) as did the postoperative morbidity rate (31.8% in group 1 vs 17.5% in gr oup 3). The five-year actuarial survival rate was respectively 18.9% and 39 .2% for groups 1 and 2 (P = 0.003); it was respectively 59.8% and 43.6% for all patients treated by adjuvant radiotherapy and for those with lymph nod e involvement. Conclusion: Prognosis of gastric adenocarcinoma is still poor. A more radic al surgical treatment did not increase the postoperative morbidity rate, bu t increased the survival rate. New adjuvant treatments including radiothera py have to be evaluated in order to improve the prognosis. (C) 2000 Edition s scientifiques et medicales Elsevier SAS.