For the purpose of evaluating recent improvements in gastric cancer surgery, a comparative analysis was made between our previously reported series of 530 curative resection cases in a 10-year period from 1961 to 1970 (group A) and the present series of 481 curative resection cases in the following 10-year period from 1971 to 1980 (group B).During the latter period, curative resections made up 74.7% of all resections (481/644) for gastric cancer, and the 5-year survival rate was 65.9% (294/446). In group B, a total of 15,512 regional lymph nodes, an average of 32.6 per specimen (30 per specimen in group A and 37.9 per specimen in group C, the last 5 years from 1981 to 1985), were removed at surgery, examined histologically for metastases, and 11.0 % were found to be positive. Of 247 patients with advanced, transmural cancers, 80.6% had lymph node metastases. Those with negative nodes showed a 5-year survival rate of 71.4%, higher than the rate of 63.5% in group A, while those with positive nodes had a 5-year survival rate of 40.6 %, significantly higher (p < 0.05) than the 29.9% rate found in group A. The 5-year survivors with positive nodes in group B made up 72.2% of all 5-year survivors, this also being significantly higher (p < 0.05) than the 58.5% noted in group A. The surgical death rate was 1.0% (5/481) of patients in group B and 1.1% (3/274) in group C.In the present study, the significance of lymphadenectomy in curative gastric cancer surgery was well documented and the results indicated that curative gastric resection with extensive lymphadenectomy can be safely performed without increasing, but perhaps decreasing, surgical mortality.
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