Morreo J A
G E N. 1979 Jul-Dec;33(3-4):315-30.
Of 102 cases of gastric carcinoma operated on, the tumor could be resected in only 53 patients. Over 60% of all cases had prolonged medical treatment before the diagnosis of gastric cancer was made. Most of the lesions were huge and locally advanced. Twenty nine operations could be considered as radical procedures, but, only fifteen of them filled the requirements of a curative radical operation (28,3%). There was no uniformity in the way that the surgical treatment was performed and too many Billroth I operations were done, (28%). This mainly because a preoperative surgical plan was not on hand. The overall surgical mortality was 14 per cent for all the cases explored, but increased to 22,5 per cent for the cases in which the tumor was resected. There was no case in which the tumor was limited to the mucosa and in the four cases classified as T1 the lesion infiltrated the muscular layer. The radical gastrectomy showed its benefits, only in those cases with limited penetration and negative nodes. This was sustained by the fact that the only survivals over ten years were four cases in the category of T2N2M0 and all of them were submitted to a radical gastrectomy. But, in advanced cases with large lesions and positive nodes the morbidity and mortality were considerable higher and survival was not even above two years. An effort in every way must be done to try to operate lesions much less advanced, but at the same time it is necessary the practice of radical surgical curate procedures in such cases.
在接受手术治疗的102例胃癌患者中，仅53例患者的肿瘤能够被切除。超过60%的患者在确诊胃癌之前接受了长时间的治疗。大多数病变巨大且局部进展。29例手术可被视为根治性手术，但其中只有15例符合根治性手术的要求（28.3%）。手术治疗的方式并不统一，毕罗Ⅰ式手术做得太多（28%）。这主要是因为没有术前手术计划。所有探查病例的总体手术死亡率为14%，但肿瘤切除病例的手术死亡率升至22.5%。没有肿瘤局限于黏膜的病例，在4例分类为T1的病例中，病变侵犯了肌层。根治性胃切除术仅在那些侵犯有限且淋巴结阴性的病例中显示出益处。这一事实得到了支持，即仅有的10年以上存活者是4例T2N2M0分类的病例，并且所有这些病例都接受了根治性胃切除术。但是，在病变大且淋巴结阳性的晚期病例中，发病率和死亡率要高得多，生存率甚至不到两年。必须尽一切努力尝试对病情较轻的病变进行手术，但同时在这类病例中进行根治性手术治疗也是必要的。
