Significance of Extirpation of Recurrent Gastric Cancer as Assessed by Survival After Recurrence

Osamu Kobayashi, Masahiro Kanari, Takaki Yoshikawa, Akira Tsuburaya, Motonori Sairenji and Hisahiko Motohashi

The Department of Gastrointestinal Surgery, Kanagawa Cancer Center

The status of patients with recurrent gastric cancer is diverse, and prognostic factor after recurrence had not been clarified yet. To evaluate the benefit of recurrent tumor removal of gastric cancer, we analyzed data on 202 patients with relapsed gastric cancer. In our series, 18 (8.9%) of the 202 underwent extirpation of recurrent tumor. The purpose of re-operation was for cure (n=9), differential diagnosis (n=5), and improvement of quality of life (QOL) (n=4). Resected tumors were located in the ovarium (n=4), colorectum (n=3), liver (n=3), lymph node (n=2), loco-regional (n=2)and peritoneum, adrenal gland, brain, and lung (n=1 each). No surgery-related mortality occurred. Disease free intervals after curative gastrectomy were 111 to 2,228 days with a mean of 934 days in the patients treated for cure, 1,038 days for diagnosis, and 1,001 days for the QOL. There was no difference in survival time among three groups. Performance status (PS) at recurrence was PS0 in 11 and PS1 in 7 patients. Six cases were presented with high serum CEA or CA19-9 levels. Locations of the recurrent tumor after re-extirpation were the recurrent sites (n=11) and multiple sites (n=6). One patient remains alive more than 5 years after hepatectomy without recurrence, while 17 died within 3 years, in which 4 after oophorectomy survived more than 2 years. Median survival after recurrence (MSTAR)or the patients treated for cure was 15.6months, that for diagnosis was 14.4 months, and that for the QOL was 11.6 months. Significant differences in survival existed between the patients for cure and the QOL (p=0.0399), for diagnosis and the QOL (p=0.0351); whereas no difference between for cure and diagnosis (p=0.8467). In the postoperative follow-up of gastric cancer, approximately 1/10 may have a chance for re-extirpation of the tumor, those patients may benefit by early detection and radical surgery in terms of survival.

Key words
gastric cancer, recurrence, metastasectomy, survival, prognosis

Reprint requests
Kobayashi Osamu Kanagawa Cancer Center 1-1-2 Nakao, Asahi-ku, Yokohama, 241-0815 JAPAN

Accepted
June 26, 2001

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