Chirurgia per carcinoma gastrico in area ad elevata incidenza:studio retrospettivo

Background and aims: Gastric cancer (GC) remains one of most worldwide frequent cancers. In Eastern Tuscany (Italy), the areas close to mountains are high-risk areas, with GC incidence and mortality significantly higher than in rest of Italy and Western European Countries. The experience in gastric surgery from a little-sized hospital located in high-risk area is reported. Methods: From 2000 to 2008, 206 patients (mean age 74.3 yrs) were diagnosed for GC. 35% of them were already in far-advanced and metastatic stage and not operated on. Surgery, post-operative mortality and morbidity, clinico-pathologic features and actuarial cumulative survival (Kaplan-Meier) were retrospectively analyzed; uni- (log rank) and multi-variated analysis (Cox’s regression) were performed. Results: In 78.8% of patients submitted to operation, radical surgery was achieved. The mean excised nodes were 31.8; only in 11% of cases less than 15 nodes were excised. Median overall survival (OS) was 51.2 mos for radical surgery vs 4.2 of palliative surgery and 5.5 of no surgery. The lympho-nodal status, the T-status, the N ratio, hystology according Lauren’s, UICC stage were all correlated with survival at univariated analysis. N ratio, N status and T status were independent prognostic factors also at Cox’s multivariated analysis. Conclusion: Endoscopic screening is desiderable in high-risk areas for GC. In the treatment of gastric cancer, radical surgery plays a lead role, but the recurrence rate is high even after curative surgery combined with extended nodal dissection. Multimodal treatments should be considered in the treatment of these patients.