FACTORS AFFECTING RECURRENCE AFTER CURATIVE RESECTION FOR GASTRIC CARCINOMA
Dr. Mesut ATLI, Dr. Murat KOLOĞLU, Dr. Çınar YASTI, Dr. Mustafa SARYAL, Dr. Uğur GÖZALAN, Dr. Nuri Aydın KAMA
Ankara Numune Eğitim ve Araştırma Hastanesi, 4. Cerrahi Kliniği, Ankara
The aim of this study was to determine the clinical and pathological factors associated with general, systemic, local or peritoneal tumor recurrence in gastric cancer patients.
Introduction: Many gastric cancer patients die of recurrences even after a curative resection. Identification of clinical or pathological factors responsible for recurrence will enable utilizing more effective treatment protocols. A total of 102 gastric cancer patients who underwent a potentially curative gastric resection between October 1991 and February 2001 at the 4th Department of Surgery, Ankara Numune Education and Research Hospital were included in this study. Twenty five clinicopathologic factors were analyzed by univariate (chi-square test, student-t test, Kaplan-Meier and log rank tests) and multivariate (logistic regression and Cox regression analyses) analyses to determine their effect on overall, local-regional, systemic and peritoneal recurrence rates.
Of the 102 patients 44 (43.1%) had recurrences during the mean follow-up period of 31.4 months (6-125 months). According to multivariate analyses, resectability and metastatic lymph node ratios were found to be the most significant independent factors. Lymph node status (1992 TNM and 1997 TNM), neural and vascular invasion were also significant factors. Extent of lymphadenectomy seemed to effect local-regional recurrence rates; invasion depth and Bormann type affected peritoneal recurrence rates.
Conclusion: Gastric cancer recurrence rates mainly depend on the stage of the tumor and the importance of early diagnosis is a well known factor. On the other hand efficacy of the surgical management is another important factor. R0 resection and metastatic lymph node ratio below 20% decreases recurrence rates. D2 lymphadenectomy is closely associated with R0 resection rate and metastatic lymph node rate and seems to be necessary for decreasing recurrence rates and for reliable staging.
Keywords: Gastric carcinoma, recurrence, lymphadenectomy.