The Role of Selective Celiac Angiography to Anticipate Prognosis of Type 4 Gastric Cancer

Hitoshi Katai¹⁾⁴⁾, Koichiro Kumai¹⁾, Tetsuro Kubota¹⁾, Keiichi Yoshino¹⁾, Kyuya Ishibiki¹⁾, Masaki Kitajima¹⁾, Makoto Mohri²⁾, Makio Mukai³⁾

Department of Surgery¹⁾, Department of Diagnostic Rediology²⁾, Department of Pathology, School of Medicine, Keio University³⁾ and Department of Surgery, Social Insurance Saitama Chuo Hospital⁴⁾

We studied the role of selective celiac angiography to predict the outcome of type 4 gastric cancer. Preoperative selective celiac angiograms of 76 gastrectomized patients with type 4 gastric cancer were analyzed. Gross findings of the resected stomachs were divided into two groups, a giant fold type including linitis plastica, and an ulceroinfiltrative type. We selected two abnormal findings, irregular narrowing of gastric wall arteries in the arterial phase (A) and disappearance of gastric wall veins in the venous phase (V). According to A and V findings, an AV-negative (A and V negative) group and an AV-positive (A and/or V positive) group were defined. The outcome of the AV-negative group was significantly better than that of the AV-positive group, especially in the giant fold type. In curatively gastrectomized patients with the giant fold type, 50% survival times in the AV-negative and AV-positive groups were 24 and 9 months respectively, and the former survival curve was statistically better than the latter. The outcome for the AV-positive patients was poorer than that for AV-negative patients, even if curative operations were performed. Histopathologically, severe lymph vessel invasion was observed in AV-positive cases. Thickening of collagen bundles was frequently found in AV-negative cases. We believed that selective celiac angiography is useful to predict the outcome of type 4 gastric cancer before surgery.

Key words
type 4 gastric cancer, survival curve of gastric cancer, selective celiac angiography

Reprint requests
Hitoshi Katai Department of Surgery, Social Insurance Saitama, Chuo Hospital
4-9-3 Kita-urawa, Urawa, 336 JAPAN

Accepted
October 7, 1992

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