<Originals>Transition of operative procedures for gastric cancer

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We reviewed the transition of procedures for operation/reconstruction and lymph node dissection of 1,469 patients who underwent gastrectomy for gastric cancer for 21 years. Furthermore, we investigated the effect these procedures had on prognosis. Gastrectomy was performed on 75.6% of the patients in Term I (1975-1980) and 90% in Terms II (1981-1985) and later (P<0.01). Curative resection was performed on 69% of the patients in Terms I and II and increased to 79% in Terms III (1986-1990) and IV (1991-1995) (P<0.01). Reconstructive procedures employed for distal gastrectomy included Billroth I and IIa, the former being used more frequently in Terms III/IV than Terms I/II. In Terms I and II, Tl invasion was in the 20% range, but increased to 40% in Term III and 45.7% in Term IV. In Terms I and II, 30-40% of lymph node dissections were of D2 and D3,while more dissections were of D1 and D2 in Terms III and IV. The 5-year survival rates in advanced cancer patients were : 48.3% in Term I, 48.5% in Term II, 50.7% in Term III, and 69.8% in Term IV, indicating significantly marked improvement in prognosis. The improvement of prognosis in Term IV despite the decrease in lymph node dissections attributed to appropriate procedure selection for gastrectomy and lymph node dissection.
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