Gastric carcinoma: curative resection and adjuvant chemotherapy

RESUMEN

A retrospective study of gastric adenocarcinoma treated with surgery as curative attempt was performed at the Oncology Service, in the Hospital Regional 20 de Noviembre, ISSSTE, Morbidity and mortality of the surgical procedures were evaluated, the significance of several risk factors factors and the survival impact of adjuvant chemotherapy with 5-fluorouracil (5-FU) and mitomycin C (MMC). In the period from 1975 to 1991 a total of 483 new cases were seen. In only 54 patients (11.2 por ciento) was it possible to undertake a curative resection. The patients were assigned to three groups of treatment surgery alone (14 cases), surgery + 5-FU (19 cases), and surgery + 5-FU -MMC (21 cases). Three different types of surgical techniques are regularly performed in our service for gastric cancer treatment Billroth II distal gastrectomy, total gastrectomy with roux-En-Y reconstruction, and esophagogastrectomy with esophagogastrostomy. Surgical morbidity and mortality was zero. Chemotherapy toxicity was transient and low, no related deaths were recorded. The prognostic factor associated significantly with survival were lymph node status and tumor penetration. The histologic differentiation as well the tumor location and type of surgery had no significance. The estimated 5-year survival of the patients treated with surgery alone was 62 per cent, while that of the patients treated with surgery plus chemotherapy was 38 per cent. These groups treated with 5-FU alone or in combination with MMC had no survival difference between them. Surgery in our institution has low morbidity and mortality. The lymph node status, as well as the tumor penetration through the gastric wall, are some of the main prognostic factors in gastric carcinoma. No improvement in survival or disease-free interval was observed when MMC was added to 5-FU. The studies aimed to demonstrate adjuvant chemotherapy effectiveness must include a group treated only with surgery and at the present time combination adjuvant chemotherapy should not be administered on a routine basis outside clinical trials