Prognostic factors in gastric carcinoma. Results of the German gastric carcinoma study 1992

Background. The impact of patient‐ and tumor‐dependent factors and the postoperative course on the prognosis of patients who underwent resection for gastric carcinoma between 1986 and 1989 were analyzed in a prospective multicenter observation study. Methods. Resection techniques, the extent of lymph node dissection, and the histopathologic assessment of the specimen were standardized at all participating centers. A total of 1654 patients were enrolled. Follow‐up is complete for 99.2% of the patients, with a median follow‐up time of 48 months. Prognostic factors were assessed by multivariate analysis. Results. In the total patient population there was an independent prognostic effect of nodal status, a International Union Against Cancer (UICC)‐R0 resection, distant metastases, the pT category, three or more risk factors on preoperative risk analysis, and the presence of postoperative complications. Multivariate analysis in the subgroup of patients who had a UICC‐R0 resection confirmed the nodal status as the major independent prognostic factor. Conclusion. These data suggest that the prognosis of patients who undergo gastrectomy for gastric carcinoma may be improved by a complete resection of the primary tumor and its lymphatic drainage, resulting in a UICC‐R0 resection. In addition, a detailed preoperative risk analysis and identification of high‐risk patients and meticulous attention to the technical details of the surgical procedure to reduce the frequency of postoperative complications may improve the prognosis.