Features of Gastric Cancer Invading Subserosal Layer

Nobuyasu Yamasaki, Kentarou Takagi, Masaki Hasegawa, Kazuhiko Manabe, Fumitaka Oike, Takanobu Koyama

Department of Surgery, Niigata Prefectural Central Hospital

Clinico-pathological factors and their influence on prognosis were studied in our 237 cases of gastric cancer invading the subserosal (ss) layer during the past 12 years. These cases were divided into three subgroups: 11 cases in ssα, 109 in ssβ and 117 in ssγ. They were compared with contemporary cases of gastric cancer invading the proper muscular layer (pm) (153 cases) and the serosal layer (se) (159 cases). Rates of lymph node metastasis (69%), lymphatic vessel invasion (83%), venous invasion (30%) and 5-year survival (56%) were all located in the middle of those for pm and se cancer. Forty-nine percent of the ss cancers and 62% of the ssγ subgroup were classified as poorly differentiated histological types. Seventy-eight percent of the ss cancers were resected curatively. As for non-curative factors, hepatic metastases were found more frequently in ssγ patients, and peritoneal dissemination or positive surgical margins were found in ssγ patients. The 5-year survival rate for ss cancer patients who received curative resection was 68%. Regarding the forms of recurrence, the same pattern was found in the ssβ and ssγ patients with non-curative factors. There was no difference in survival of ssβ and ssγ patients for 4 years after curative resectin, but a gradual decline in the survival rate was found in ssγ cases thereafter. Further examination revealed that late recurrences (more than 4 years after the operation) were found mainly in ssγ patients as local or lymph node recurrence or peritoneal dissemination. These results suggest that the ssγ type of cancer tends to cause micro-involvement of cancer distant from the main lesion.

Key words
gastric cancer invading subserosal layer, peritoneal dissemination of gastric cancer, retroperitoneal infiltration of gastric cancer, late recurrence of gastric cancer, micro-involvvement of gastric cancer

Reprint requests
Nobuyasu Yamasaki Department of Surgery, Niigata Prefectural Central Hospital
3-20 Ootemachi, Jouetsu, 943 JAPAN

Accepted
January 8, 1992

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