J.Jpn. Surg. Soc.. 60(2): 347-367, 1959
CANCER OF THE STOMACH AN ANALYSIS OF 1,029 CASES
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Tsuda Surgical Department, Okayama University Medical School Seiji TSUDA, Hitoshi OMORI, Kaiso SANO |
2) The male : female ratio is 1.8 : 1.
3) Age incidence is greatest in the 6th decade of life, and successively the 5th and 7th decades.
4) Hereditary disposition is seen in 29.5 per cent of all cases.
5) The type of blood is not related to the incidence of carcinoma.
6) In the first symptoms epigastric pain is most predominant, and successively sense of fullness and belching. Diarrhea is a noticeable symptom as one of the first symptoms.
7) Present symptoms on admission is most frequent in sense of fullness. and followingly weight loss and pain.
8) Preoperative duration of symptoms is most common from six months to one year.
9) In the past history 29.3 per cent of all cases has symptoms of stomach disease.
10) Palpability rate of tumor on admission is 97,4 per cent.
11) Positive diagnosis of cancer by roentgenological examination is 89.6 per cent.
12) Anemia (below 4 million of R.B.C.) is disclosed in 66.5 per cent of all cases, and 61.9 per cent is less than 75 per cent in hemoglobin concentration by Sahli. No specificity is encountered in W.B.C..
13) In the quantitative determinations of free hydrochloric acid 78.7 per cent of all cases is found to be achlorhydric or hypochlorhydric.
14) Of the patients tested for occult blood in the stool, positive rate is 73.5 per cent in Benzidine test and 64.8 per cent in Pyramidone test.
15) Location of the tumor is abound in pyloro-antral region.
16) Size of tumor is most common from small-fist to fist size (51.9 per cent).
17) Extragastric adhesion of carcinoma is not detected grossly in only 9.1 per cent.
18) Regional lymphnode swelling is not seen in only 4.1 per cent.
19) In the type of tumor classified by Borrmann's II type is most common (43.8 per cent).
20) Serosal involvement is proved in 85.7 per cent of all cases.
21) Histologically, carcinoma simplex is 28.3 per cent, cylindrical cell carcinoma 19.7 per cent, so-called adenocarcinoma 20.0 per cent of all cases. Few scirrhous, infiltrating and colloid carcinomas are present.
22) Operability rate is 94.9 per cent of all admitted cases, and resectability rate is 63.4 per cent of all cases who underwent operation.
23) Total resection of the stomach is performed on 11.1 per cent of all cases who underwent resection, and in combined resection the transverse colon is most frequently subjected.
24) Hospital mortality rate for all resected cases is 9.7 per cent and its main causes are leakage and peritonitis.
25) In follow-up data (93.0 per cent of all cases responded), excluding operative mortality, three-year survival rate is 29.8 per cent and five-year survival rate is 15.9 per cent. Comparing the survival rates between fore period (1942 to 1948) and later period (1049 to 1955), three-year survival rate shows no difference but the five-year survival rate is 13.2 per cent and 19.4 per cent respectively.
26) Prognosis of cancer is unable to predict according to the preoperative duration of symptoms.
27) On the gastric acidity three-year survival rate is lowest in the hyperacidity group and five-year survival rate is higher in the normo-and hyperacidity one.
28) On the location of tumor the prognosis is worst in cancer of the cardia and of the entire corpus. Carcinoma of the pylorus is also bad in prognosis.
29) Prognosis is better when the lesion is smaller and the adhesion is less.
30) Lymphnode swelling has no relation to five-year survival rate, but to three-year survival rate, better in the negative cases.
31) Borrmann's II. type is best in prognosis.
32) Prognosis is superior when carcinoma is confined to the submucosa of the stomach.
33) Adenocarcinoma and cylindrical cell carcinoma are better in prognosis and others are not. C.P.L. classification by Prof. Imai is valuable in judging the prognosis.
34) Survivors over five years are 40 cases in total and longest one is 14 years and 4 months.
35) Culpability for the delay in diagnosis of cancer lies in both physicians and patients, and no-delay is only 17.8 per cent.
(authors' abstract)
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