Carcinoma of the stomach

Guarded optimism regarding treatment of carcinoma of the stomach is justified. Results of a personal series of 254 patients staged according to a simple clinical classification is presented. Eight of ten patients with A-I lesions (no metastasis, primary lesion confined to the inner coats of the stomach) are alive and well five or more years after surviving definitive resection. Fifty-five per cent of all patients who had no involved nodes are alive and well five years or more after resection. On the other hand, none of ninety-six patients with C lesions (distant metastasis) in whom a biopsy only was performed was alive one year after operation. Three principles governing treatment are emphasized: 1. 1. With rare exceptions the patient with suspected gastric malignancy should have surgical exploration. 2. 2. At operation, if the lesion is potentially curable, the surgeon's principal objective is wide excision of the primary lesion, without biopsy, including en bloc excision of any involved adjacent nonessential structures. 3. 3. If the lesion is incurable, palliative procedures should be used with restraint in view of the high mortality, morbidity and frequent failure of palliation. Obstruction will be the chief indication for attempted palliation.