Das magenfrühkarzinom im patientengut eines deutschen high-volume-zentrums

Introduction: Diagnosis and therapy of early gastric cancer (EGC) experienced a gradual change over the recent years due to better diagnostic techniques and new treatment strategies. In how far has this change affected the surgical therapy of EGC in Germany? The present study tries to answer this question by analyzing the EGC-cases of a German high-volume centre over the last 25 years. Patients: Between July 1982 and December 2006 2,183 patients underwent gastrectomy for gastric cancer at the Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany. 1,744 patients underwent primary surgery without preceding neoadjuvant chemotherapy, 421 (24.1%) of which had EGC. In the subgroup of EGC 43.5% of cases showed mucosal cancer (pT1a) while in 56.5% of cases the submucosa was involved (pT1b). To assure comparability of results the present analysis confines itself to those patients who underwent primary gastrectomy. Results: A relative increase of earlier tumor-stages could be observed over the years. Endosonography showed a high accuracy (87.9%) in the diagnosis of EGC in the hands of an expert. Patients with EGC were of younger age and in a better general condition compared to patients with more advanced gastric carcinoma. EGC were predominantly localized in the distal third of the stomach (45.6%), while more advanced tumors were mostly found in a proximal location (52%). Only 11.2% of EGC cases showed lymph-node involvement. In EGC as well as more advanced cancers a total gastrectomy was performed in most cases (46.5% vs. 76.4%). Postoperative complications were significantly less common after surgical resection of EGC than after resection of more advanced tumors (19.4% vs. 26.4%; p = 0.004; χ²-test). This tendency could also be observed for postoperative mortality, did however not reach the level of significance (1.7% vs. 3.2%; p = 0.106; χ²-test). 5-year-survival was 82.5% for patients with EGC, while the subgroup of more advanced gastric carcinoma showed a 5-year-survival of 26%. Conclusion: The increase in the percentage of patients undergoing surgery for EGC certainly results from better diagnostic and screening methods and also an increased acceptance of those methods by patients and family doctors. Some of the results from this analysis, e.g. the higher prevalence of advanced tumors at the esophago-gastric junction, are certainly the result of the area of expertise of the institution in which the patients were treated.