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Aims of the Study: The 5-year survival rate of gastric cancer is less than 20% in cancer registries. The prognosis of early gastric cancer is much better but this diagnosis is rare in Europe. The aim of the study was to evaluate the prognosis and trends in the incidence of early gastric cancer in the area of Calvados (France) during a 13-year period., Methods: Between 1978 and 1990 the Digestive Cancer Registry of Calvados recorded 1,160 new cases of gastric cancer. The diagnosis of early gastric cancer was defined according to the Japanese Gastroenterological Society criteria. Prognostic factors were determined with univariate and multivariate analysis., Results: One hundred patients had early gastric cancer (8.6%). This rate did not change significantly during the period. The mean age was 64.2 +/- 1.5 in males and 64.8 +/- 2.2 in females and 39% of patients were older than 70. A precancerous condition was present in 56% of cases on the surgical specimen. A total gastrectomy was performed in 23% of cases and a subtotal gastrectomy in 72% of cases. The postoperative mortality was 5% and the 5-year relative survival was 86.8% +/- 4.6. Univariate and multivariate analysis found a better prognosis in patients younger than 75 or in patients with a superficial or excavated gross appearance compared with those older than 75 or with a protruded type. Lymph node metastasis, depth of invasion, size of the tumor and histologic differentiation did not influence significantly the outcome., Conclusion: According to the data of the Cancer Registry of Calvados the proportion of Early Gastric Cancer was low and did not change between 1978 and 1990. The prognosis of EGC is good, mainly altered in elderly and in cases with a protruded type.

Objectives: The aim of this study was to determine trends in incidence and survival for gastric cancer in the department of Calvados over a ten-year period., Methods: Between 1978 and 1987, 999 patients with gastric cancer were registered by the Registry of digestive tumours of Calvados. Standardized incidence rates were calculated for males and females and for each site of the tumour in two consecutive 5-year periods: period I: 1978-1982; period II: 1983-1987. Then prognostic factors were determined with univariate and multivariate methods., Results: Global incidence rates were 15.7/100,000 in men, and 6.7/100,000 in women. Incidence rates of antropyloric carcinomas significantly decreased in women (period I: 3.6/100,000, period II: 2.1/100,000; P < 0.01). The incidence rate of cancer of the cardia did not change in men (period I: 2.7/100,000, period II: 2.9/100,000; NS) nor in women (period I: 0.6/100,000, period II: 0.3/100,000; NS). The ratio of early gastric cancer was respectively 8% and 9.2% (NS). The frequency of "signet ring" cells carcinomas increased from 20% during period I, to 34% during period II (P < 0.05). Overall 5-year survival rate was 16%; it was 26.3% after resection, without significant change between the two periods (27% versus 24.4%). The multivariate study in gastric cancer after resection pointed out 5 prognostic factors: age over 75 years, invaded resection margins, lymph node involvement, metastases and parietal wall involvement., Conclusions: The results of this epidemiologic study in the department of Calvados indicate that a) the global prognosis of gastric cancer was poor and did not change over the 10 years of the study; b) incidence rates of antropyloric carcinomas slightly decreased in women; c) rates of early gastric cancers did not increase.

The effectiveness of adjuvant radiotherapy (ART) in the treatment of rectal cancer (RC) is established for the local control of the tumor, but doubt remains as concerns improvement in survival. The aim of this work was to assess the present techniques and trends of ART in a French department based on a population-based study. From 1978 to 1986, 616 cases of RC were diagnosed in the department of Calvados (France). Tumor was removed in 346 patients (56 percent). Of these 346 cases, 29 percent were irradiated, 3/4 postoperatively and one forth preoperatively. Besides sex and age, the type of surgery (anal sphincter saving or not) and Dukes' tumor stade had an influence on the performance of ART. Thirty-one percent Dukes B tumors and 42.1 percent of Dukes C tumors were irradiated. The practice of ART for these tumors increased significantly from 1978 (18.5 percent) to 1986 (60 percent) (P less than 10(-4)). However, the practice and the distribution of centers performing ART were heterogenous within the department of Calvados. This heterogeneity was neither due to the environment (urban/rural) of the patient nor to the distance between the place of residence and the radiation therapy center. Such an heterogeneity could be explained only by the lack of consensus concerning the practice of ART. Such a consensus could be found considering the results of the latest controlled clinical trials, but definitive conclusions are needed about the effectiveness of ART on the improvement of survival.

During a seven year period ending in 1984, the Calvados Registry of Digestive Tract Tumors (France) recorded 1446 cases of colorectal cancer. The sex-ratio, age, and histologic type were studied with respect to location. From cecum to rectum, the sex-ratio varied from 1 to 1.9. Average age at diagnosis varied between 67.5 and 72.6 years for women but was invariable for males. The proportion of mucinous carcinoma varied between 13 p. 100 in the cecum and 5 p. 100 in the sigmoid and rectum. The study of incidence with respect to age and location showed that there were less elderly women with left colonic and rectal carcinoma. Epidemiologically, there seems to be two different types of colonic carcinoma: proximal and distal colonic carcinoma (including the rectum), the separation being determined by the splenic flexure.

Five surgical centers conducted a clinical randomized prospective trial in order to objectively evaluate the two-year results of three anti-reflux procedures regularly performed in France: complete (360 degrees) fundoplication (Nissen), posterior partial (180 degrees) fundoplication (Toupet) and cardiophrenopexy (Lortat-Jacob). Fifty-two patients, mean age 53 years, range 28 to 74 yrs, with uncomplicated gastroesophageal reflux, as defined according to clinical, radiologic, endoscopic and pHmetry criteria, were included in this study. Twenty patients underwent a Nissen procedure, 18 had a Toupet procedure, while 14 had a Lortat-Jacob procedure. The main criterion of assessment was Minaire's pHmetry score evaluated at two years postoperative. All three groups were well matched for clinical, radiologic, endoscopic, manometry and pHmetry findings. At two years, the number of asymptomatic patients did not statistically differ within the three groups. Four patients, however, required reoperation for invalidating recurrences: three following Lortat-Jacob's procedure and one after Toupet's procedure. Nissen's and Toupet's procedures significantly improved pHmetry scores compared with Lortat-Jacob's procedure; pHmetry was improved, but non significantly, by Nissen's procedure, as compared with Toupet's procedure. Lower sphincter pressure was significantly increased (p less than 0.01) by Nissen's procedure as compared with the two other techniques. The lower sphincter was significantly lengthened by Nissen's and Toupet's procedures as compared with Lortat-Jacob's technique (p less than 0.01). The total length of esophagus was significantly increased (p less than 0.01) by Nissen's and Lortat-Jacob's procedures in comparison with Toupet's technique. The distance separating the lower sphincter of the esophagus and point of pressure reversal was significantly decreased (p less than 0.05) by the Nissen procedure only.(ABSTRACT TRUNCATED AT 250 WORDS)

Over a five year period (1978-1982), 520 new cases (males = 492, females = 28) of esophageal carcinoma (OC) have been registered in the department of Calvados in Normandy (589,000 inhabitants). Data were collected from Hospital records, pathological institutes and physicians. Mean age was 62.1 years in males, 70.1 years in females (p less than 10(3]. A higher incidence was observed among farmers and workers in rural areas. A previous or synchronous cancer (mostly oro-pharyngeal) was associated in 86 patients (16.5 p. 100). Fourty-nine p. 100 of OC were located in the middle third of the esophagus. Histologic type was squamous cell in 91 p. 100, adenocarcinoma in 3 p. 100, and undifferentiated carcinoma in 6 p. 100. Esophageal resection was performed in 63, radiation therapy in 294, palliative surgical procedure in 91, and symptomatic treatment in the others. The overall 1-year survival rate was 31 p. 100 and the 5-year survival rate was 3 p. 100. Excluding patients with associated cancer, the survival rates were 40.5 p. 100 and 7.6 p. 100, respectively. In France, the department of Calvados has the highest incidence of OC. The standardised incidence rate in males (31.6/100,000) in Calvados is exceeded only in four countries in the world. Decreasing incidence (4.6 p. 100 each year) has been observed during the past six years (p less than 0.05).