Survival following surgical treatment of gastric cancer. A challenge for the community endoscopist.

The management of 124 patient diagnosed with adenocarcinoma of the stomach from 1971 to 1990 was reviewed. Early gastric cancer increased from 0% to 9% of the cases between the first and last quarter of the study. Proximal gastric cancer similarly increased from 8% in the first decade to 29% of all cases diagnosed during the second decade of the study. Follow-up information was available for all patients. Nineteen patients (15%) had no operation and two survived more than 2 years. Twelve patients had a surgical biopsy only and four had a palliative bypass; none survived 2 years. Eighty-six patients (69%) had a surgical resection with a 30-day operative mortality of 8% and a 5-year survival of 17%. Prognosis was significantly better for patients with T-1 and T-2 tumors and for those with distal cancers. Patients with early gastric cancer had 67% 5-year survival. These data should encourage efforts to improve the diagnosis of early gastric cancer.