The Current Situation Of Surgical Treatment For Gastric Cancer

Objective: Gastric carcinoma, one of the most common malignant tumors, although its morbidity and mortality have been declining in recent years, is the first leading cause of cancer-related mortality in China. The patient's number of death for gastric cancer is about 160 thousand every year in our country. This study wished to investigate appropriative way to improve curative effect and survival rate of surgical therapy for gastric cancer through analysis of prognostic factors of 814 cases underwent gastric resection. Methods: 814 patients with gastric carcinoma who were operated upon in the department of abdominal surgery in Tianjin medical university clinical institution from October, 1995, were followed up until April, 1999. The survival rates were analysed with Kaplan-meier and then analysed with univarite and multivariate analysis of cox regression. Results: (l)Of 814 cases, 497 have died. The median survival time of them was 29 months.The 1-year over-all survival rate was 71.87%, The 3-year over-all survival rate was 45.33%, The 5-year over-all survival rate was 40.05%. 13.27% of them have recurred within half a year, 25.21% within one year, 46.02% within three years and 51.54% within five years. (2)Univariate analysis showed that the predictors of survival in gastric cancer patients were weight loss,swallow difficult,tumor location,Bornnann type,preoperative metastases,way of resection,radical resection,intraoperative metastases,combined resection,time of chemotherapy,pathological type,depth of tumorinvasion,lymph node metastases,TNM staging.(3)Multivariate analysis showed that four major significant prognostic factors as Borrmann types, radical gastrectomy, time of chemotherapy and TNM staging.(4)764 patients of 814 gastric cancer patients were operated tumor,the gastrectomy rate was 93.9%.64.6% of 814 patients with gastric cancer were approached Dl resection, 19.9% of them were approached D2 resection,9.4% of them were approached palliative resection.The one-year survival rate of Dl resection was 79.92%,three-year survival rate was 49.81%,five-year survival rate was 43.94%.The one-year survival rate of D2 resection was 85.00%,three-year survival rate was 61.87%,five-year survival rate was 55.62%; The one-year survival rate of palliative resection was 28.38%,three-year survival rate was 8.11%,five-year survival rate was 5.41%.(P<0.001)Conclusion: To improve the survival rate of gastric cancer, the reasonable plan of gastrectomy should be drawn up and the synthetic treatment around gastrectomy should be performed basing on biological characteristic of each patient such as TNM clinical stage, Borrmann type and so on.