Clinical Analysis of Perforated Gastric Cancer

PURPOSE: Generalized peritonitis caused by a free perforation of gastric cancer is a rare condition, which occurs in 1~4% of all gastric cancer patients. To assess the characteristics of the patients and investigate the optimal treatment of choice, the data from 51 patients previous recent 10 years were retrospectively analyzed. METHODS: Between 1988 and 1997, 51 patients underwent surgical treatment for perforated gastric cancer. The clinicopathological features and survival rates of the resected group (n=39) and the non-resected group (n=12) were analyzed. RESULTS: The incidence was 0.78% and the mean age was 57 years. The most common tumor location was in the lower 1/3 in the resected group (n=21, 53.8%) and in the upper 1/3 in the non-resected group (n=6, 50%). Borrmann type 3, the poorly differentiated type, and a positive serosa invasion were more common in both groups. Liver and peritoneal metastases were observed in 2 cases (5.2%) and 7 cases (14.3%) in the resected group, and 4 cases (33.4%), and 3 cases (25%) in the non-resected group, respectively. Resectability found in 76.5%: 27 cases of a subtotal gastrectomy and 12 cases of a total gastrectomy. A limited lymph node dissection (D0, D1) was performed in 14 cases (35.9%) and an extended dissection (D2, D3) was performed in 25 cases (64.1%). The 5-year survival rate of stage I was 80%, 40% in stage II, 14% in stage III and 0% in stage IV, and the overall 5 year survival rate was 20.5% in the resected group and 0% in the non-resected group. The depth of invasion, lymph node metastasis and tumor stage significantly influenced the survival rate of the patients. CONCLUSION: Because a perforation of the gastric cancer may develop in every stage, surgeons must take care of these patients by the same way as with non-perforation cases.

Prognostic Significance of Lymphatic and Perineural Invasions in Patients with Gastric Cancer Who Have No Lymph Node and Serosal Involvement

PURPOSE: The most important prognostic factors in gastric cancer are depth of invasion and lymph node metastasis. Therefore, the prognosis for serosa and lymph node negative gastric cancer is favorable. However, there is no general agreement on the prognostic factors in this subset of patients. This study was undertaken to evaluate the prognostic significances of venous invasion (VI), lymphatic invasion (LI), and perineural invasion (NI) in T1 and T2 gastric cancer without lymph node involvement. MATENRIALS AND METHODS: We retrospectively evaluated 206 patients with T1 and T2, lymph node negative gastric cancer who underwent a curative resection from 1989 to 1993 at Kangnam St. Mary's Hospital, Seoul, Korea. The Chi-square test was used to determine the statistical significance of differences, and the Kaplan-Meier method was used to calculate survival rates. Significant differences in the survival rates were assessed using the log-rank test, and the Cox regression method was used to evaluate independent prognostic significance. RESULTS: The rate of VI, LI and NI correlated well with the depth of tumor invasion. The rates of VI (+) for T1 vs T2 was 0% vs 5.1%, of LI (+) was 5.6% vs 26.8%, and of NI (+) was 1.6% vs 26.8% in NI (+). There were 13 recurrent cases, 10 cases out of the 13 were T2 gastric cancers, and the recurrence rate was higher in LI (+) andNI (+) cases than in LI (-) and NI (-) cases. The 5-year survival rates were 93.4% in LI (-) cases, 77.4% in LI (+) cases, 92.5% in NI (-) cases, 74% in NI(+) cases, 95.9% in LI (-) NI (-) cases, and 73.9% in LI (+) NI (+) cases. Multivariate analysis demonstrated that simultaneous LI and NI was the only significant factor influencing the prognosis. CONCLUSION: These results suggest that simultaneous lymphatic and perineural invasion may be an independent prognostic factor in patients with T1 and T2 gastric cancer without lymph node metastasis.