RADICAL SURGERY FOR GASTRIC-CANCER IN SINGAPORE

This study was conducted to define the pattern and results of gastric cancer surgery in Singapore by reviewing the epidemological data from the Singapore Cancer Registry together with a review of a personal series of 182 patients operated on over a 141/5-year period. As in Japan and the West, the incidence of gastric cancer is decreasing in Singapore; it was 2.3% per year for men and 1.5% for women in the period 1968-1982. Nevertheless, the disease is still common and the respective age-standardized rates among the ethnic Chinese in Singapore of 37.3 and 15.4 per 100,000 per year remain higher than in the West but are only about half the rate observed in Japan. These rates in Singapore Chinese are also-higher than those seen in the Chinese-Americans in the United States, but are lower than those of the Chinese of Shanghai, which suggests that lifestyle and diet influence the incidence of gastric cancer. In the series of 182 patients, gastric adenocarcinoma occurred in the antrum or body or the whole stomach in 78.5% and in the cardia in 21.5%. Presentation was late: stage I, 10%; stage II, 7.7%; stage III, 28%; and stage IV, 54.3%. Surgical resection was performed whenever technically possible (146 patients, 80%). In 86 patients, all macroscopic tumors were excised by a radical resection approximating the R2 type of resection, with only one operative mortality. In the cohort of patients operated on more than 5 years ago for carcinoma of the antrum or body, 25 of 51 patients have survived 5 years; 30 patients had stage III disease and 12 of these are 5-year survivors. The results of the present series of advanced gastric carcinoma treated by radical resection outside Japan appears encouraging in terms of the low operative mortality and long-term survival.