Surgery for stomach cancer in a defined Swedish population: current practices and operative results. Swedish Gastric Cancer Study Group.
OBJECTIVE
To study routine surgical in-hospital care, and to relate postoperative morbidity and mortality to age, sex, tumour stage, operation done, and surgical workload of the hospital.


METHODS
Prospective population-based study.


METHODS
All hospitals that diagnosed new cases of stomach cancer in five counties in central and northern Sweden, 1 February 1989-31 January 1995.


METHODS
All 1024 patients diagnosed as having a new adenocarcinoma of the stomach.


RESULTS
The stomach cancer was in such an advanced stage at diagnosis that only half of the patients could be offered a potentially curative operation. The tumour was resectable in 632 patients (62%). Distal gastric resection was done for 359 (57%) and total gastrectomy in 259 (41%) of all the resected cases. Postoperative complications occurred in 250 patients (31%). In multivariate analyses the relative risk (RR) for postoperative complications increased to 2.3 (95% confidence interval [CI] = 1.3 to 4.3) in patients over 79 years of age compared with those under 60. The corresponding RR for postoperative death was 5.1 (95% CI = 2.0 to 12.7) in patients over 79 years. Total gastrectomy combined with splenectomy and distal pancreatectomy carried the highest postoperative morbidity (RR = 3.3) and mortality (RR = 3.7) compared with distal gastrectomy.


CONCLUSIONS
There was no difference in postoperative morbidity or mortality among different types of hospital categories. Surgical treatment of stomach cancer still carries a substantial morbidity and mortality in an unselected series of patients, particularly among elderly patients.
Hansson
L E
LE
Department of Surgery, Mora Hospital, Sweden.
Ekström
A M
AM
Bergström
R
R
Nyrén
O
O
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome