Affiliation:
1. The Norwegian Stomach Cancer Trial, Department of Surgery and Section for Medical Informatics and Statistics, University of Bergen, Haukeland sykehus, Norway
Abstract
Abstract
A total of 1165 patients with stomach cancer were entered into a prospective, observational national study. They represented 54 per cent of all stomach cancer patients reported to the Cancer Registry in Norway during the study period, and data are analysed for three hospital levels (local, county and university hospitals). The median age was 71 years (range 18–96 years). The median pretreatment delay was 113 days, and 46 per cent of patients had a performance status (Karnofsky index) of 80. The diagnosis was confirmed by pre-operative histology in 88 per cent of cases. In all, 88 per cent of patients underwent surgery, the resectability rate was 67 per cent and 50 per cent had a potential curative operation. Total gastrectomy was most commonly performed. Lymph node dissection was performed in 14 per cent of those undergoing a curative resection. The postoperative complication rate was 27 per cent but varied with the type of operation, being highest in proximal resection (55 per cent) and lowest after distal resection (19 per cent). A total of 7 per cent of the patients died postoperatively. Most patients had advanced disease at the time of treatment and only 6 per cent had stage I tumours. There were significant differences in patient and treatment characteristics between the three hospital levels. In conclusion, patient selection bias which will influence results does occur. A fairly aggressive attitude towards local disease was found; but the low proportion of patients undergoing lymph node dissection not only leads to questions regarding the efficacy of this treatment policy, but also casts doubt on the validity of staging of stomach cancer. Morbidity and mortality rates are still high. The consequences of the differences revealed between hospital groups are difficult to interpret. Proponents of both regionalization of treatment and small hospital care may find arguments for their case in the data.
Publisher
Oxford University Press (OUP)
Reference34 articles.
1. Estimates of the worldwide frequency of the twelve major cancers;Parkin;Bull World Health Org,1984
2. The surgical treatment of cancer of the stomach;Yamada;Int Surg,1980
3. Outcome of gastric carcinoma detected by gastric mass survey in Japan;Kaneko;Gut,1977
4. Changing state of gastric cancer in Japan;Nagato;Am J Surg,1983
5. Surgical treatment of gastric carcinoma. A regional study of 2590 patients over a 27-year period;Inberg;Arch Surg,1975
Cited by
35 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献