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Gastric Carcinoma: An eleven year review of 792 cases

Yonsei Medical Journal 1965년 6권 1호 p.95 ~ 105
 ( Min Kwang-Sik ) - 연세대학교 의과대학 외과학교실

 ( Weiss Emest W. ) - 연세대학교 의과대학 외과학교실
 ( Rice Roberta G. ) - 연세대학교 의과대학 외과학교실
 ( Whang Kyu-Chul ) - 연세대학교 의과대학 외과학교실
 ( Hur Kyung-Bal ) - 연세대학교 의과대학 외과학교실
김춘규 ( Kim Choon-Kyu ) - 연세대학교 의과대학 외과학교실
김광연 ( Kim Kwang-Youn ) - 연세대학교 의과대학 외과학교실
윤세옥 ( Yoon Sei-Ok ) - 연세대학교 의과대학 외과학교실
서상현 ( Suh Sang-Hyun ) - 연세대학교 의과대학 외과학교실

Abstract


Statistical analysis of 792 cases of gastric carcinoma is reported. Materials were collected from the medical record room during the 11 year period from Jan. 1955 to Dec. 1965. Diagnosis of gastric carcinoma was established by pathologic examination of the resected specimen, by lymph node biopsy, and by physical and X-ray findings. The age of peak incidence was in the 5th decade. The male to female ratio was 3:1. In the order of frequency, the symptoms and signs which were the most prominent and common were epigastric pain or discomfort, indigestion, anorexia, a palpable mass, weight loss, and epigastric tenderness. More than 50% of the patients had symptoms for less than 6 months. About 70% of the patients and hypochlorhydria on gastric analysis. More than 60% of the carcinomas were located in the prepyloric region. Regional lymph-node metastasis was present in 76% of the cases. In order of frequency this occurred in the omentum, celiac nodes, liver, pancreas, and mesocolon.

There was a 56.4% operability and 58.8% resectability. The most common postoperative complication was wound infection. There were 9 operative deaths which made a 3.4% mortality for cases resected, and 2% mortality for all cases coming to surgery.

The five year survival rate was 12.9% for all cases coming to surgery, but was increased to 22.2% for patient having a total gastrectomy and 24.2% for patients having a subtotal gastrectomy. 12.0% of patients having gastrectomy in which there were positive nodal metastases survived five years, but, when metastasis was not noted the patients who had had a gastrectomy survived at a rate of 45.5% for five years. The surgical result was influenced by several fastors other than the presence or absence of metastases to the lymph nodes. These factors included the grade of the tumor microscopically, the presence or absence of serosal involvement, and the pathologic type of the tumor.

It is our opinion that our surgical results, which are poor when compared with those in the literature, are due mainly to the fact of a late diagnosis. Some of the patients were so far-advanced as to be questioned as to their being candidates for surgery. Most of the patients come to the surgeon simply because of their symptoms and signs which have developed beyond the point of tolerance, or because of family pressures to come for treatment.

This study revealed that the resectability rate, and the surgical results improved year by year. This fact explains why the early diagnosis is so very important. It is felt keenly that education of the public and increased alertness on the part of both patients and physicians is needed. This is particularly true when the patient is over 40 years of age, complains of indigestion, epigastric pain or discomfort. Each of these patients should have a complete check-up. Once the chance for cure of the disease has passed it is difficult to do more than a palliative procedure.

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