We reviewed cases at our institution in an attempt to identify temporal trends in survival of patients with operable gastric cancer. We analyzed data on 1632 patients who received a diagnosis of gastric adenocarcinoma between 1975 and 1995 and who underwent surgery at our institution. The time trends were examined by comparing three time periods (1975-1984, 1985-1989 and 1990-1995). Over time there was an improvement in the R0 resection rate: the rate significantly increased from 65% to 83%. Short-term outcomes following surgery have improved, with 30-day mortality dropping from 3.5% to 1%. The overall survival curve continuously improved with time. The five-year survival rates improved from 43% to 61%. The increased use of extended lymph node dissection with careful examination for metastases allowed for more accurate TNM staging. The incidence of peritoneal failure remains high, with peritoneal recurrence observed in 49% of the patients who underwent R0 resection between 1985 and 1995 and who experienced recurrences. Our results demonstrated that current efforts to improve gastric cancer management are finally meeting with noticeable success. However, advanced-stage cancer remains a medical problem. Multimodal treatment of advanced disease will be an important theme in coming years.

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