[Trends in stomach carcinoma. A statistical analysis of 1204 cases]. / Il carcinoma dello stomaco in prospettiva. Analisi statistica di 1.204 casi.

The authors report a retrospective analysis of their experience of gastric cancer. One thousand two hundred and four patients, observed between 1977 and 1994, of whom 1,094 underwent surgery, were studied. Data analysis was performed, dividing this period as follows: 1977-1982, 1983-1988, 1989-1994. The results reveal that, over time, substantial changes occurred both in tumor characteristics and surgical approach. With regards to tumor characteristics, the disease weighs heavily, even if it is less frequent than in the past (25% reduction), striking younger subjects and presenting in increasingly more aggressive forms [higher frequency of proximal (+11.4%) and diffuse forms (+18.1%), reduction of advanced forms (-11.6%) not proportional to the increase of early forms (+64.5%), as well as increase of cases with a short clinical history (+15.2%)]. In terms of surgical approach, while the use of conservative surgery was reduced during the study period, extensive procedures were more widely used, particularly in the curative treatment of advanced tumors (subtotal gastrectomies: reduction of 39.5%; total gastrectomies: increase of 106%). The increasing use of extended surgery is linked to the modifications occurred in tumor characteristics and in pre and post-operative management rather then to changes in surgical approach. It must be noted, however, that such technical advances have not yielded an improvement in survival (p = n.s.); as such, it is likely that gastric cancer has became a more aggressive disease and, therefore, has counterbalanced the benefits of early diagnosis and extended exeresis.

Prognostic significance of CEA, CA 19-9 and CA 72-4 preoperative serum levels in gastric carcinoma.

The prognostic value of preoperative serum levels of CEA, CA 19-9 and CA 72-4 tumor markers was investigated in 153 patients resected for gastric cancer. The positivity rates for CEA, CA 19-9 and CA 72-4 were 20.9, 34.6 and 28.1%, respectively. Multiple logistic regression analysis for positive levels of tumor markers indicates that CEA positivity is significantly related to the depth of invasion (p < 0.005) and the presence of distant metastasis (p < 0. 05), CA 19-9 positivity is related to nodal involvement (p < 0.05) and the depth of invasion (p < 0.05), whereas CA 72-4 positivity is influenced by tumor size (p < 0.005) and noncurative surgery (p < 0. 05). Positive levels of each tumor marker were associated with a worse prognosis if compared with negative cases using univariate analysis. Multivariate analysis of curatively resected cases identified depth in gastric wall (p < 0.0001), nodal status (p < 0. 0005), and tumor location in the upper third (p < 0.05) as significant prognostic variables; CEA, CA 19-9 and CA 72-4 serum positivity did not reach statistical significance. However, when the positivity of the three markers was associated, a p value < 0.05 was observed. The analysis of survival curves stratified by tumor stage revealed that marker positivity significantly affects survival in stages I, II and IV (p < 0.05). The combined assay of CEA, CA 19-9 and CA 72-4 preoperative serum levels provides additional prognostic information in patients resected for gastric cancer; patients with preoperative positivity for one of these tumor markers should be considered at high risk of recurrence even in early stages of gastric carcinoma.

Complications after surgery for gastric cancer in patients aged 80 years and over.

Recent studies have shown a considerable increase in the number of aged patients with gastric cancer. In this retrospective study, we report our 18-year experience with 110 patients aged 80 years and over affected with this neoplasm. Postoperative morbidity and mortality rates and risk factors affecting their incidence were examined by univariate and multivariate analysis. Operability and resectability rates were 70.9% and 47.3% respectively. Of the resective procedures, 41 (78.8%) were subtotal gastrectomies. In five cases (9.6%), we performed combined resections. Twenty-five patients (32.1%) experienced postoperative complications; overall mortality rate was 12.8% (10 patients). In resective procedures, morbidity and mortality were 26.9% and 3.8% respectively, which are very low rates compared to other Western reports. Statistical analysis identified the number of preexisting medical illnesses as an independent predictor of morbidity and mortality. Crude five-year survival rate of curatively resected cases was 43%. Although multiple medical illnesses involved much higher operative mortality, neither the presence of postoperative complications nor the number of preexisting medical illnesses significantly influenced five-year survival rate of curatively resected patients. With careful evaluation and selection of patients, correct treatment of concomitant diseases and adequate peri- and postoperative care, gastric surgery provides good immediate and long-term results even in very old patients. Subtotal gastrectomy with limited lymphadenectomy should be the preferred procedure; total gastrectomy, combined resections and extended lymphadenectomy should be performed only when necessary, in patients with fewer than two illnesses. Surgery should be avoided in patients with highly advanced disease, if multiple medical illnesses are present.

[A case of pancreatic somatostatinoma]. / Considerazioni su un caso di somatostatinoma a localizzazione pancreatica.

The authors describe a case of somatostatinoma localized in the body and tail of the pancreas. They emphasize the rarity of this finding (only 33 cases with certain pancreatic localization are reported in literature) and the absence of a distinctive syndrome, which could direct to an early diagnosis, the authors are in doubt about the real incidence of this disease. The absence, generally, of a distinctive syndrome, the poor condition of these patient and then the lack of surgical treatment and histological examination, could lead to a lower valuation. Delayed diagnosis and then the local extension of this neoplasm often make surgical treatment vain. Nevertheless since somatostatinoma has more possibilities of radical resection than pancreatic cancer, it's required to know its features and course so to increase possibilities of an early diagnosis. In fact disregarding surgical treatment, the survival of these patients, one year after diagnosis, is about 48%. This result is better than the survival of patients with pancreatic or biliary duct cancers. Current diagnostic procedures are reported.

[Preoperative serum levels of CEA and CA19-9 in patients with gastric cancer]. / Livelli serici preoperatori di CEA e CA19-9 in pazienti affetti da carcinoma gastrico.

The serum level determination of tumor markers in gastric cancer, more than other neoplasia, presents, many difficulties for the impossibility to identify specific molecules released during neoplastic growth. In this research the authors report their experience on the preoperative determination of two tumor markers diffusely used in gastrointestinal neoplasia: CEA and CA19-9. The study has been done in order to establish relations between the expression of markers and some considered variables. The values have been studied on 113 patients. A total of 24% sensibility was reported for CEA while 48% for CA19-9 applying cut-off levels of 10 mg/ml and 37 U/ml respectively. The results have shown a better sensibility of CA19-9 with a statistical significance between the expression of this marker and stage of disease (from 21% to 66%), lymph nodal involvement (from 31% to 59%), histologic grading (from 39% to 48%) and surgical purpose (from 37% to 78%) (p < 0.001).