1Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea. 3Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
ABSTRACT
PURPOSE: Our aim was to determine the patterns of recurrence after curative resection of gastric cancer and to analyze the factors related with recurrence. We hypothesized that aggressive surgical approach including extended lymphadenectomy performed during last several decades may alter the patterns of recurrence.
MATERIALS AND METHODS: A retrospective analysis of 91 patients with recurrent gastric cancer after curative surgery at Department of Surgery, College of Medicine, The Catholic University of Korea, from 1989 to 1992.
RESULTS: Average time to recurrence was 21.8+/-17.9 months and 64 cases(70.3%) were recurred in 24 months after surgery. The most common type of recurrence was peritoneal dissemination(46.2%), followed by distant lymph node metastasis(24.2%), hematogenous metastasis(19.8%), and local recurrence(7.7%). Borrmann type III and IV, serosal invasion, lymph node metastasis, lymphatic and perineural invasion were the factors associated with recurrence. In peritoneal dissemination, serosal invasion and poorly differentiated adenocarcinoma were high risk factors. Mean duration of life after recurrence was 5.4+/-5.2 months.
Re-operation was performed in 12 cases(13.2%), and survival was longer in resection cases compared to non-resection cases(10.9 vs 3.8 months)(p=0.034).
CONCLUSION: With the use of aggressive surgical approach, relative incidence of local recurrence has been lowered. On the other hand, peritoneal seeding was the most frequently encountered pattern of recurrence. Serosal invasion, Borrmann type III or IV and poorly differentiated adenocarcinoma were risk factors for peritoneal recurrence.
Intensive follow-up examination is strongly suggested during the first 24 months after curative surgery for advanced gastric cancer because of high probability of recurrence in this period. Surgical resection for locally recurrent gastric cancer seems to prolong survival time.
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