Factors influencing survival of patients after radical surgery for gastric cancer. A regional study of 406 patients over a 10-year period.

The present retrospective report presents a review of prognostic factors influencing the survival of 406 gastric cancer patients radically operated on in the Tartu Oncology Hospital, Estonia in 1978-1987. All patients underwent total (n = 170) or subtotal (n = 236) gastrectomies with extensive lymphadenectomy (260 R2- and 146 R3-resections) according to the General Rules for the Gastric Cancer Study in Surgery and Pathology established by the Japanese Research Society for Gastric Cancer, introduced in our hospital at the end of the 1970s and now used as the unavoidable procedure for curative gastric cancer surgery. The 30-day postoperative mortality was 5.9% and the overall 5-year survival 46.1%. The male:female ratio was 0.95 and the mean age 62.4 years. Only 7.6% of all our patients operated on had early gastric cancer with a 5-year survival of 80.7% whereas 76.8% had T3-T4 tumours with a 5-year survival of 41.0%. Lymph node involvement was found in 44.6% of the patients. Independent favourable prognostic factors were (the 5-year survivals are presented within parentheses): limited (N0-N1) lymph node involvement (56.4 vs. 22.6%), pT 1-2 stage (62.8 vs. 41.0%), papillary, tubular or poorly differentiated histological pattern (51.9 vs. 33.1%), subtotal gastrectomy (55.9 vs. 32.4%) and age below 70 years (51.9 vs. 35.2%). Sex of patients, Borrmann type, size and site of tumour were not statistically associated with prognosis at multivariate analysis. Our results also suggested that besides predetermined prognostic factors, the surgical policy had a great impact on the prognosis of gastric cancer patients. We conclude that gastrectomy with combined resections of neighbouring organs directly invaded and with extensive lymphadenectomy at least up to the second node group might be the procedure of choice for advanced gastric cancer.