DRG Category: 326

Mean LOS: 16.6 days

Description SURGICAL: Stomach, Esophageal, and Duodenal Procedure with Major CC

DRG Category: 374

Mean LOS: 5.9 days

Description MEDICAL: Digestive Malignancy with CC

classification section:



Gastric cancer is a relatively uncommon malignancy, accounting for approximately 2% of all cancers in the United States but is the second-most common cancer worldwide. In 2008 in the United States, it is estimated that 21,500 people were diagnosed with gastric cancer and that 10,880 died of the disease. This type of cancer, like lung cancer, is primarily found in the seventh decade of life.

Nearly 95% of gastric neoplasms are classified as adenocarcinomas; these tumors develop from the epithelial cells that form the innermost lining of the stomach's mucosa. The most common sites for cancer in the stomach include the antrum, the pylorus, and along the area of lesser curvature. According to the Lauren classification, gastric adenocarcinomas are divided into two main histologic types: diffuse and intestinal. The diffuse type is ill defined, infiltrates the gastric wall, and lacks a distinctive mass. The intestinal type, by contrast, is composed of neoplastic cells that cluster together, resembling glands; it is associated with a better prognosis, as are tumors along the area of lesser curvature. A poor prognosis is associated with tumors of the cardia or the fundus.

Metastasis occurs via the lymphatics and the blood vessels by seeding of peritoneal surfaces or by direct extension of the tumor. Sites of metastasis are the liver, lungs, bone, adrenals, brain, ovaries, colon, and pancreas. Intestinal tumors are more likely to spread to the liver, whereas diffuse-type tumors are more likely to spread along peritoneal surfaces. Other complications include malnutrition, gastrointestinal (GI) obstruction, and iron deficiency anemia.