Early gastric cancer: report on 142 patients observed over 13 years.

Between 1977 and 1989, 958 patients were admitted for gastric carcinoma to the Second Department of Surgery, University of Siena, Italy. Of these, 142 (15%) had early gastric cancer. The diagnosis of this form of cancer has increased from 7% in 1977 to 22% in 1989. Following a detailed analysis of the clinical data and diagnostic techniques, it can be concluded that endoscopy is a far better method for diagnosis than x-ray. The data presented in the present paper strongly support this conclusion. Tumors were classified according to the Japanese Research Society Committee on Histological Classification of Gastric Cancer. The five-year survival rate which we have obtained is 89%, slightly lower than that of Japanese authors, but higher than that reported by other western authors. Lesions confined to the mucosa were observed in 75 patients (52.8%) while those involving the submucosa were observed in 67 patients (47.2%), with survival rates of 94 and 85%, respectively. Lymph node involvement was present in 14 cases (9.8%), with primary lymph nodes (N1) in 11 cases (7.7%) and secondary lymph nodes (N2) in three (2.1%). The five-year survival rates, with respect to lymph node involvement, was 57% in the presence of lymph node metastases and 93% in their absence (P < 0.001). The lesions were frequently found to be localized in the lower third of the stomach (106 cases, 74.6%). Patients with such lesions had a survival rate of 93%, a significant difference from those cases with lesions localized in the middle or upper third of the stomach (P < 0.05). The surgical treatment preferred in our Institute, has been subtotal gastrectomy associated with lymphadenectomy R1 and R2, leaving total gastrectomy for lesions localized in the upper third of the stomach.