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Of 242 gastric cancer patients undergoing surgery in this clinic between 1979 and 1986, 84 (35%) were aged over 70. Staging of patients by the UICC (1978) classification was I: 4.8%, II: 16.7%, III: 18% and IV: 60.5%. Resection rate was 71.4% (60/84) with postoperative hospital mortality of 11.7% (7/60). Mortality in non-resected patients was 25% (6/24). Mortality after total gastrectomy was 11% and after distal resection 5.3%. Actuarial 5-year survival with curative resection was 43.5%, whereas no patient with palliative resection was alive 2 years (range 2-22 months) after surgery (p less than 0.01). These results show that curative resection is the therapy of choice even in elderly patients, due to the low operative risk and excellent survival.

Data on 25 early and 227 advanced gastric cancer patients treated surgically in our clinic over an eight-year period from 1979 to 1986 have been analyzed retrospectively. In 45.5% (n = 110) curative resection and in 27.3% (n = 66) palliative resection was performed. In another 27.3% (n = 66) only a non-resecting procedure was possible. The overall hospital mortality was 10.7% (26/242). It was 9.1% (16/176) after resection and 15% (10/66) after non-resecting procedures. Total gastrectomy "de principe" with compartment II lymphadenectomy was performed in 70.5% (124/176). Total hospital mortality was 8.9% (n = 11) and leakage of the proximal anastomosis was observed in 8.1% (n = 10). Hospital mortality of the remaining resected patients was 3.2% (1/31) after distal resection, 20% (3/15) after proximal resection and 16.7% (1/6) after total esophagogastrectomy with colon interposition. All patients were staged according to UICC classification and staging was I 8.5%, II 14%, III 23% and IV 54.5%. Actuarial 5-year survival in all patients surviving resection was depending on stage of disease at operation (stage I 100%, II 53.3%, III 29% and IV 0%). It differed most significantly (p less than 0.001) for curative (49%) and palliative resections (0%). These results indicate that improvement of results requires early diagnosis with immediate surgical intervention.

To evaluate the prognostic difference between the 2 major histological types of Lauren classification in gastric cancer, data on patients who underwent the same surgical procedure -- total gastrectomy -- were studied. 124 consecutive total gastrectomy cases treated from 1979 to 1986 were classified according to Lauren retrospectively into 2 groups, comprising 63 patients (50.8%) with intestinal type carcinoma and 61 in another group of diffuse (n = 44, 35.5%) or mixed type (n = 17, 13.7%) carcinoma. In regard to extent of total gastrectomy the two groups were comparable (splenectomy 50 times and compartment II lymphadenectomy 43 times in the intestinal type group, vs 49 and 39 times in the diffuse or mixed type group). The proportion of males (42 men, 21 women) and older patients (mean: 62 years) was greater in the intestinal type group than in the group of diffuse or mixed type carcinoma (34 men, 27 women, mean: 57 years). According to TNM stage no significant difference was observed in local tumor infiltration (pT stage), lymph node metastases (pN) and distal metastases (pM) between the two groups at the time of surgery. The stages of disease (UICC 1987) were similar in the two groups: Stage I: intestinal type 25.4% (16/63), diffuse or mixed type 23% (14/61), stage II: 19% (12/63) vs 14.7% (9/61), stage III: 14.3% (9/63) vs 19.7% (12/61), stage IV: 41.3% (26/63) vs 42.6% (26/61). The hospital mortality was 9.5% (6/63) in the intestinal-type group and 8.5% (5/61) in the group of diffuse or mixed carcinoma (no significant difference).(ABSTRACT TRUNCATED AT 250 WORDS)