title: Trends and results in treatment of gastric cancer over last two decades at single East European centre: a cohort study.
abstract: BACKGROUND
  A steady decline in gastric cancer mortality rate over the last few decades is observed in Western Europe. However it is still not clear if this trend applies to Eastern Europe where high incidence rate of gastric cancer is observed.
  
  
  METHODS
  This was a retrospective non-randomized, single center, cohort study. During the study period 557 consecutive patients diagnosed with gastric cancer in which curative operation was performed met the inclusion criteria. The study population was divided into two groups according to two equal time periods: 01-01-1994 - 31-12-2000 (Group I - 273 patients) and 01-01-2001 - 31-12-2007 (Group II - 284 patients). Primary (five-year survival rate) and secondary (postoperative complications, 30-day mortality rate and length of hospital stay) endpoints were evaluated and compared.
  
  
  RESULTS
  Rate of postoperative complications was similar between the groups, except for Grade III (Clavien-Dindo grading system for the classification of surgical complications) complications that were observed at significantly lower rates in Group II (26 (9.5%) vs. 11 (3.9%), p = 0.02). Length of hospital stay was significantly (p = 0.001) shorter (22.6 ± 28.9 vs. 16.2 ± 17.01 days) and 30-day mortality was significantly (p = 0.02) lower (15 (5.5%) vs. 4 (1.4%)) in Group II. Similar rates of gastric cancer related mortality were observed in both groups (92.3% vs. 90.7%). However survival analysis revealed significantly (p = 0.02) better overall 5-year survival rate in Group II (35.6%, 101 of 284) than in Group I (23.4%, 64 of 273). There was no difference in 5-year survival rate when comparing different TNM stages.
  
  
  CONCLUSIONS
  Gastric cancer treatment results remain poor despite decreasing early postoperative mortality rates, shortening hospital stay and improved overall survival over the time. Prognosis of treatment of gastric cancer depends mainly on the stage of the disease. Absence of screening programs and lack of clinical symptoms in early stages of gastric cancer lead to circumstances when most of the patients presenting with advanced stage of the disease can expect a median survival of less than 30 months even after surgery with curative intent.
authors.affiliation: Department of Surgery, Lithuanian University of Health Sciences, Eiveniu Str, 2, Kaunas LT-50009, Lithuania. a_mickevicius@yahoo.com.
authors.forename: Antanas
authors.initials: A
authors.lastname: Mickevicius
authors.forename: Povilas
authors.initials: P
authors.lastname: Ignatavicius
authors.forename: Rytis
authors.initials: R
authors.lastname: Markelis
authors.forename: Audrius
authors.initials: A
authors.lastname: Parseliunas
authors.forename: Dainora
authors.initials: D
authors.lastname: Butkute
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Kiudelis
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Endzinas
authors.forename: Almantas
authors.initials: A
authors.lastname: Maleckas
authors.forename: Zilvinas
authors.initials: Z
authors.lastname: Dambrauskas
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D005743:Gastrectomy; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome