Gastric cancer: three decades of surgical management.

Hospital records of all 277 patients who underwent surgery for gastric adenocarcinoma at the University of California at Los Angeles Medical Center from 1970 through 1996 were reviewed. Patients were stratified into three groups comprising 1970 to 1979, 1980 to 1989, and 1990 to 1996. The incidence of stage IV disease decreased by 50 per cent over the course of the study (P < 0.001). Lymph node involvement declined by 30 per cent (P < 0.01). Endoscopy displaced contrast radiography as the primary diagnostic modality. Sensitivity of endoscopic biopsy averaged 92 per cent. Twice as many patients were resected for cure in the current decade compared with the 1970s (P < 0.001). Operative mortality was less than 2.5 per cent for the entire period studied and has been nil in the 1990s. Intraoperative blood loss and transfusion requirements also decreased significantly each decade. Hospital stay was shortened by 41 per cent and the length of postoperative stay in the intensive care unit decreased from a median of 4 days to zero. Five-year survival improved significantly during the study period, mirrored by an increase in survival for early cancers. We have found an earlier presentation of gastric adenocarcinoma over the past 3 decades that parallels an increased use of endoscopy and an improved sensitivity of endoscopic biopsy. More patients are now resectable than in previous decades. Survival after surgical treatment of gastric adenocarcinoma improved between 1970 and 1996, partially due to an increase in earlier stage lesions. Improved survival is also demonstrable when only early stage cancers are considered.