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Jeong, Cho, Lee, Kim, Kang, Kim, and Kim: Usefulness of Reoperation after Recurrence of Gastric Cancer
Original Article
Journal of the Korean Surgical Society

Journal of the Korean Surgical Society 2009; 77(2): 96-105.

Published online: 4 August 2009

DOI: https://doi.org/10.4174/jkss.2009.77.2.96

Usefulness of Reoperation after Recurrence of Gastric Cancer

Gui-Ae Jeong, M.D., Ph.D., Gyu-Seok Cho, M.D., Ph.D., Moon-Su Lee, M.D., Ph.D., Yong-Jin Kim, M.D., Ph.D., Kil-Ho Kang, M.D., Hyung-Soo Kim, M.D., Hyung-Chul Kim, M.D., Ph.D.

Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.

Corresponding author (gschogs@schbc.ac.kr)

Received 10 May 2009       Accepted 8 June 2009

Copyright © 2009 The Korean Surgical Society

Abstract

Purpose

Radical gastrectomy and lymph node dissection is the treatment of choice for gastric cancer but the efficacy of surgical treatment of recurrent gastric cancer has been debated. We evaluated the efficacy of surgical treatment for recurrent gastric cancer.

Methods

We collected the data on 108 recurrent gastric cancer patients who underwent radical gastrectomy and lymph node dissection for gastric cancer and analyzed the clinicopathologic data, the patterns of recurrence of gastric cancer, and the strategies of treatment for recurrent gastric cancer.

Results

The patterns of recurrence were 32 locoregional, 26 hematogenous, 24 peritoneal, and 26 mixed recurrences. The strategies of treatment for recurrent gastric cancer were the combination of surgical treatment and chemotherapy in 31 cases (28.7%), chemotherapy alone in 49 cases (45.4%), and conservative treatment in 28 cases (25.9%). The morbidity and mortality in reoperation group were 35.5% and 9.7%, respectively. The mean survival after recurrence was 25.4, 12.7, and 4.9 months in reoperation group, chemotherapy group and conservative treatment group, respectively. In multivariate analysis, the differentiation of primary tumor, patterns of recurrence, and the strategies of treatment for recurrent gastric cancer were related with survival after recurrence of gastric cancer.

Conclusion

Our data suggested that the more aggressive and intensive treatment such as surgical treatment could improve the survival rate for recurrent gastric cancer. Therefore, if the patients' conditions are tolerable and there is resectability, surgical treatment may be an applicable strategy for recurrent gastric cancer in terms of long-term survival.

Keywords: Gastric cancer, Recurrence, Reoperation, Survival

Figures and Tables

Fig. 1
Patterns of recurrence and recurrent sites. 26 patients had two or more recurrence sites (mixed recurrence).
jkss-77-96-g001
Fig. 2
Survival after recurrence of gastric cancer according to differentiation of primary cancer (A), patterns of recurrence (B), and the strategies of treatment for recurrent gastric cancer (C).
jkss-77-96-g002
Table 1
Clinicopathologic factors of recurred gastric cancer patients
jkss-77-96-i001

*TG = total gastrectomy; †STG = subtotal gastrectomy; ‡LN = lymph node; §CTX = chemotherapy.

Table 2
Types of treatment after recurrence of gastric cancer
jkss-77-96-i002

*CR = complete resection; †PO = palliative operation; ‡CTX = chemotherapy; §BSC = best supportive care; ∥LN = lymph node.

Table 3
Types of reoperation after recurrence of gastric cancer
jkss-77-96-i003

*There was one case of postoperative mortality; †Subtotal colectomy was done for reason of obstruction of colon due to peritoneal metastasis; ‡Extended right hemicolectomy was done for reason of obstruction of transverse colon, but some part of tumor was remained; §There were two cases of postoperative mortality.

Table 4
Morbidities and mortalities of reoperation after recurrence of gastric cancer
jkss-77-96-i004
Table 5
Univariate and multivariate analysis for survival after recurrence
jkss-77-96-i005

*SD = standard deviation; †RR = relative risk; ‡CI = confidence interval; §LN = lymph node; ∥BSC = best supportive care.

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