Surgical Treatment of Gastric Cancer in Albania

Abstract

Objective: Gastric cancer is a major health problem, although its incidence has somewhat declined during the last years. The study aims to give a complete overview of the surgical treatment of gastric cancer in the First Service of General Surgery UHC “Mother Theresa” in Tirana, Albania. Methods: Our study presents extensive evidence of 624 patients, operated in the First Service of General Surgery UHC “Mother Theresa” in Tirana, Albania with the diagnosis of gastric cancer in the last eleven years. The study analyses demographic, clinic, operative and pathologic data of the patients obtained from clinical, operative and pathologic records. Results: M : F ratio was 2:1. The average age of all patients was 59.5 +/- 11.6 (18 – 90) years: in the age-group 51 – 70 years were 61.2% of all patients. The patients were divided in three groups according to the localization of the tumor: gastric cardia and fundus tumors were found in 105 (17%) patients, gastric corpus tumors were found in 279 (44.7%) patients and gastric antrum and pylorus tumors were found in 240 (38.3%) patients. The UICC/AJCC (TNM) classification was as follows: stage 1 were 49 (8%) patients; stage 2 were 174 (28%) patients; stage 3 were 213 (34%) patients and stage 4 were 188 (30%) patients. Overall operability index was 70%; 188 (30%) patients resulted inoperable at the time of intervention. In gastric cardia and fundus tumors, the most performed operation was total gastrectomy (70.5% of operable patients). In gastric corpus tumors, the most performed operation was distal gastrectomy (54%), followed by total gastrectomy (42% of operable patients). In gastric antrum and pylorus tumors, all operable patients (100%) were treated with distal gastrectomy. In the histopatologic aspect, most of the tumors were adenocarcinoma (74.7%). Overall postoperative morbidity and mortality were respectively 26.8% and 1.8%. The most common postoperative complications were cardiopulmonary complications in 44 (7%) patients and wound infection in 37 (6%) patients. Conclusions: In the curative surgical treatment of advanced gastric cancer, the procedure of choice is closely associated with the stage and localization of tumor. In the gastric antrum and pylorus tumors the procedure of choice is distal gastrectomy; otherwise in the gastric cardia and corpus tumors the most performed operation is total gastrectomy.