Factors Influencing Recurrence after Curative Resection for Advanced Gastric Cancer

ABSTRACT

PURPOSE: Despite radical lymph node dissection and combined resection, the operative results of treating advanced gastric cancer remains inadequate. The aim of this study was to determine the risk factors for recurrence of gastric cancer and the pattern of recurrence after curative resection for advanced gastric cancer. METHODS: Out of 220 patients who underwent curative resection for advanced gastric cancer from 1990 to 2000, 50 whose recurrence was confirmed by clinical, radiological, endoscopic or reoperative findings were studied retrospectively. We undertook a detailed analysis of the pattern of recurrence based on the morphologic and histopathologic characteristics of the initial tumor. RESULTS: The mean time to recurrence was 19.0 months. Early recurrence was found in 38 patients (76.0%), intermediate recurrence was found in 11 patients (22.0%), and late recurrence was found in 1 patient (2.0%). The patterns of recurrence were as follows: hepatic recurrence was found in 14 cases, peritoneal recurrence in 19 cases, local recurrence in 10 cases, extraperitoneal recurrence in 6 cases. In univariate analysis, the depth of invasion, extent of lymph node metastasis, TNM stage, and combined resection were important for recurrence. In multivariate analysis, depth of invasion and lymph node metastasis were important for recurrence. CONCLUSION: The peritoneal recurrence was the most frequently encountered pattern of recurrence. The two years following surgery was the most important period for recurrence. Depth of invasion and lymph node metastasis were related to recurrence with statistical significance. Since the results of treatment remain dismal, studies of perioperative adjuvant therapy in an attempt to reduce recurrence are warranted.