Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980-1985.
An audit of treatment of gastric carcinoma was conducted in a major general hospital unit in the UK over a 5-year period. In all, 206 patients (114 men, 92 women) with a mean age of 68 years were treated. Operation was performed in 150 patients; 87 underwent gastrectomy with 31 procedures appearing potentially curative. Most tumours were advanced at diagnosis: 92 were stage IV and 34 stage IIIB, with 42 tumours at earlier stages. After the 87 gastrectomies anastomotic leakage occurred in 16 patients (18 per cent) and there were 14 deaths (16 per cent). The rates of resectability, inadequate resection, anastomotic leakage and postoperative mortality varied considerably between surgeons. The 5-year survival rate was 5 per cent overall, 11 per cent after gastrectomy and 32 per cent following curative resection. The results of treatment of gastric cancer by general surgeons are poor and show marked variation between operators. The declining incidence of the disease makes prospective audit difficult. Treatment by fewer surgeons specializing in this area might improve the outcome.