Palliation for "advanced" gastric cancer.

Abstract

The authors retrieved the medical records of 98 patients with “advanced” gastric carcinoma who underwent laparotomy over a period of 2 years (March 2003 to February 2005). Survival data was available for 42 of the 98 patients. Fifteen out of these 98 patients could be followed up at the time of the study. These 15 patients underwent either gastric “resec-tion” (n=10) or gastric “bypass” (n=5). The aim of the study was to ascertain whether surgery (resection versus bypass versus neither) had palliated the symptoms in patients with “advanced” gastric carcinoma. I would like the authors and the editors of the Indian Journal of Surgery to clarify certain issues regarding the article.Firstly, the authors do not state their defi nition of “ad-vanced” gastric carcinoma. On careful scrutiny of the data presented in Table 1, we fi nd 32 out of the 98 patients un-derwent gastric resection. Only 21 patients out of the 32 however, had either serosal spread (n=10), adhesion to pan-creas (n=2) or other organs (n=5), omental deposits (n=1) or free fl uid (n=3). This implies that 11 or more patients who underwent gastric resection may not have had features of “advanced” gastric carcinoma. Unfortunately, the patholog-ic staging for gastric cancer (as proposed by the American Joint Committee on Cancer), was not ascertained in any of the patients in this study.The authors state elsewhere that “in patients undergoing gastric bypass or exploratory laparotomy alone, the tumor progress to a