Results of treatment of stomach cancer. An appraisal of efforts for more extensive surgery and a report of 1,983 cases

Abstract

A study was mude of 1,983 cases of cancer of the stomach seen at the University of Minnesota Medical Center between 1936 and 1963. Emphasis was placed on those patients seen from 1958 to 1963, as efforts were being made then for widespread employment of more extensive surgical excision procedures in order to achieve a higher cure rate in patients with this disease. For the entire series of patients seen between 1936 and 1963, the overall 5-year survival rate was 10.2%; the most favorable 5-year rate was 12.2% and was recorded for those seen 1950--1958. During the most recent period of study (1958--1963), and during the time of the philosophy of extensive lymph node dissections, the operative mortality for partial gastrectomies performed for cure rose to 25.6% and for total gastrectomies to 33.3%. During this same time, the 5-year survival rate for those operated upon for cure (which had reached a peak of 28% for the 1950--1958 period) fell to 17%. Five-year survival for patients with positive lymph node gastric cancer who underwent resections for cure declined more sharply—from 18% to 9%. The overall 5--year survival rate for all patients seen fell from 12.2% for the earlier group to 8.8% for those seen during the later period. It would appear that further improvement in patient survival likely will not occur as a result of routine employment of more extensive surgical excisions and lymph node dissections in the treatment of patients with cancer of the stomach.