Management of Gastric Carcinoma at Aichi Cancer Center -An Audit of 4,839 Cases Treated During the Past 25 Years and Reports on the Recent Advances in Detection and Treatment of Distant Metastases-

Yoshitaka Yamamura, Yasuhiro Kodera, Yasuhiro Shimizu, Akihito Torii, Takashi Hirai, Kenzo Yasui, Takeshi Morimoto, Tomoyuki Kato, Tsuyoshi Kito, Yasuaki Arai*

Department of Gastroenterological Surgery, Department of Diagnostic Radiology*, Aichi Cancer Center Hospital

1) During the 30 years since the establishment of Aichi Cancer Center, there has been a marked increase in the proportion of early gastric carcinomas (especially of mucosal cancers) and a corresponding decrease in non-resectable cases. Operation was performed on 4,839 patients during the 25 years between 1965 and 1989. These 25 years were divided into 5-year groups numbered I to V, and treatment outcome was compared according to period. An increase of 20% between groups I and V was observed in the 5-year survival rate of patients rated as curability A or B (n=3,600). No stet difference was observed in patients rated either curability C or not resectable. The improvement in survival rate was especially prominent in 395 patients with t₂ n(+) status. The improvement in outcome after surgery in patients in groups III to IV was so great that no survival benefit of adjuvant chemotherapy was observed in these groups. 2) Highly sensitive detection of intraperitoneal free cells by polymerase chain reaction-mediated amplification of carcinoembryonic antigen mRNA was performed in 150 patients. Five of the 16 patients who were positive for carcinoembryonic antigen mRNA but negative by the conventional cytology examination, have been found to have peritoneal metastases thus far. 3) Intra-arterial chemotherapy, consisting of 5-fluorouracil, mitomycin C, and adriamycin, through indwelling catheters was performed in 40 patients with hepatic metastases. The response rate was 72%, including 6 cases with a complete response, resulting in 50% survival of 15 months.

Key words
survival rate after curative gastrectomy, free tumor cells in peritoneal washes, hepatic arterial infusion chemotherapy

Reprint requests
Yoshitaka Yamamura Department of Gastroenterological Surgery, Aichi Cancer Center Hospital
1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681 JAPAN

Accepted
July 22, 1998

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