In Japan, there is an attempt to establish some criteria for the surgical operation of stomach cancer patients in an effort to improve the distal result of operation.
This author has participated in a conference to provide such criteria and is responsible to clarify their adequacy.
In this connection, a total of 194 stomach cancer patients received Gastrectomy in the author's clinic during the 7 years period from 1956 to 1962 were employed in the present study and comparisons were made between the findings at the time of operation and postoperative distal results.
According to the provisional criteria stated above, the operations which are free from any intraperitoneal dissemination, hepatic metastasis, cancerous adhesion to the surrounding organs, and those in which the removal of regional lymphnodes is complete sufficiently covering the scope of any possible metastasis, and also when the histological pictures of the each extremely of the removed stomach deny the presence of cancerous cells, they are called“curative operation”, while those which do not satisfy above criteria are called“non-curative operation”.
First, when classified macroscopically by the surgical operator, out of the 194 cases of Gastrectomy stated above, 127 cases were curative operations and the remaining 67 were non-curative ones. On careful investigation of the histological preparations of their removed samples, additional 27 cases were transf ered from the group of curative operations to that of the non-curative ones. Because, the presence of cancerous cells at the end of the dissection was suspected in 22 cases and lymphatic metastasis was found in the other 5 cases.
The 1 year survival rate of thus histologically corrected curative operations was 86 %, 3 years survival rate 59 % and 5 years survival rate was 62 %. The survival rates of non-curative operations were 25 %, 2 % and 0 % respectively.
The findings stated above confirmed that the criteria employed in the classification of curative and non-curative operations of gastric cancer were in complete agreement with their distal results, and thus, it has been concluded that the operations of gastric cancer should be made to satisfy all the criteria of curative operations.
Aside from the pathohistological conditions regulating curative operations, various biological characteristics of cancer, which have been claimed by a number of senior investigators to be closely related to the distal results, such as Borrmann's types, histological types of infiltration, extent of the cancerous infiltration into the gastric wall have also been confirmed to be significant for the judgement of distal results.
View full abstract