The treatment of gastric cancer with combined surgical resection and chemotherapy

A series of 156 patients with gastric cancer during a 15 yr period were studied to determine the effectiveness of combined surgery and adjuvant chemotherapy. The patients were divided into a 9 year pre chemotherapy period and a 6 year chemotherapy period. Available data were reviewed retrospectively for stage of disease, treatment modality, and survival. Age distribution was similar but the median age was a decade earlier in the second group. Incidence of distant disease was 46.4% in the second group compared to 36.8% in the first group. Treatment modalities for the first and second groups respectively were: biopsy only 32.4% and 32.8%; surgery only 36.5% and 25.4%; surgery and adjuvant chemotherapy 4.1% and 34.3%; and chemotherapy only 27.0% and 7.5%. Survival expressed as percent of patients surviving revealed: an increase at one year from 46.7% for surgery alone to 73.9% for surgery and adjuvant chemotherapy; an increase at two years from 40.0% to 47.8%; and no increase at 3 years. Five year results were similar. Comparison of results of surgery alone and surgery and adjuvant chemotherapy for patients with regional disease showed: an increase from 46.7% to 85.7% at one year; an increase from 40.0% to 64.3% at 2 years; an increase from 26.7% to 35.7% at 3 years; and no difference at 4 years and after. This data has suggested that surgery and adjuvant chemotherapy increased one, two and three year survival rates but did not affect the long term result.