Results of surgery for gastric cancer and effect of adjuvant mitomycin C on cancer recurrence

Abstract

Abstract This study involved 1628 patients who underwent surgery for gastric cancer between 1964 and 1973. No gastric resection was performed in 330 patients because of extensive cancer, and all died within 2.5 years. A noncurative resection was performed in 286 patients and most of these died within 3 years, although 12.2% survived for 5 years and 9.7% survived for 8 years. Of the 995 patients who underwent a curative resection in which all macroscopic cancer was removed, 63.7% survived for 5 years and 58.3% survived for 8 years. Survival was directly related to the stage of cancer at the time of operation; in the 9th postoperative year it was 80% in stage 1,48% in stage II, and 19% in stage III. Evaluation of the influence on survival of the two major staging criteria showed that serosal invasion by cancer had a substantially greater negative effect on survival than regional lymph node metastases. In the absence of serosal invasion (even when there were regional lymph node metastases), recurrence usually took the form of hematogenous metastases to the liver rather than peritoneal disease, indicating that it was possible to eradicate all local disease by surgery, but not to eliminate disease in the blood vessels or bloodstream. In the hope of improving the survival rate obtained by curative resection of gastric cancer, investigators in 19 cooperating hospitals have conducted 4 separate studies of surgical adjuvant chemotherapy with mitomycin C (MMC), involving 2636 patients. Administration of MMC twice weekly for 5 weeks after curative resection increased the overall 5‐year survival rate by 13.5% and produced a highly significant 36.6% increase in 5‐year survival in patients with stage II cancer. MMC was particularly effective in preventing hematogenous metastases to the liver in patients who did not have serosal invasion, but it was not effective when the cancer invaded the serosa.