Gastric cancer: A curable disease in Britain

Abstract

Objective - To determine whether more vigorous efforts aimed at earlier diagnosis allied to radical surgical resection lead to improved survival of patients with gastric cancer. Design - Prospective audit of all cases of gastric cancer treated during 1970-89. Setting - Department of surgery, general hospital. Subjects - 493 consecutive patients with gastric adenocarcinoma. Main outcome measures - Operative mortality, postoperative morbidity, and five year survival after radical potentially curative resection. Results - 207 (42%) patients underwent potentially curative resection. The proportion of all patients in whom this was possible increased significantly (p<0·01) from 31% in the first five year period to 53% in the last five year period. The proportion of patients who had early gastric cancer rose from 1% to 15% (p<0·01) and stage I disease rose from 4% to 26% (p<0·001). After potentially curative resection, mortality 30 days after operation was 6%. Operative mortality decreased from 9% in the 1970s to 5% in the 1980s. Likewise, the incidence of serious postoperative complications decreased from 33% in the 1970s to 17% in the 1980s (p<0·01). Five year survival was 60% in patients who underwent curative resection, 98% in patients with early gastric cancer, and 93%, 69%, and 28% in stage I, II, and III disease respectively. By the late 1980s five year survival after operation was about 70%. Conclusions - These findings suggest that an increasing proportion of patients with gastric cancer could be diagnosed at a relatively early pathological stage when about two thirds are curable by means of radical surgery.