Clinical analysis of recurrence after gastrectomy for early gastric cancer / 解放军医学杂志

ABSTRACT

Objective To analyze clinicopathological characteristics of recurrence after gastrectomy for early gastric cancer. Methods 308 patients were treated surgically for early gastric cancer from 1983 to 2005. 245 patients were followed up after gastric resection.Clinicopathologic factors were investigated by using univariate methods and multivariate analysis for the possible relationship to recurrence. Results 30 patients developed recurrent disease (median 28 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 5.49%, 8.44%, 11.27%, 14.83%, 16.39% and 37.79%, respectively. 13 patients with mucosal gastric cancer developed recurrent disease (median 24 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 4.23%, 6.68%, 7.75%, 9.34%, 9.34% and 28.24%, respectively. 17 patients with submucosal gastric cancer developed recurrent disease (median 31 months). The 1-year, 3-year, 5-year, 7-year, 10-year and 15-year recurrent rates were 7.39%, 11.14%, 16.54%, 24.49%, 29.69% and 64.85%, respectively. Cox multivariate analysis showed that submucosal invasion (P=0.044, OR=2.172) was a positive independent risk factor and paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.047, OR=0.460) was a negative independent risk factor for recurrence. 76.7% (23/30) patients with recurrence did not have indication of resection for a cure, and they did not undergo surgery again. 23.3% (7/30) patients with recurrence had indication for curative resection, and 4 of whom underwent curative resection, but 3 did not because of poor health. Pathological examination after surgery showed that in 3 patients there was early gastric cancer in the remnant stomach without lymph node metastasis, and in one patient there was advanced gastric cancer in remnant stomach with regional lymph node metastasis. The patient with advanced gastric cancer survived for 28 month without detectable tumor. Logistic regression analysis showed paracarcinomatous mucosal medium-severe intestinal metaplasia (P=0.016, OR=17.000) was a positive independent predictor for second radical surgery. The follow-up examinations including endoscopy were performed in 86.7% (26/30) of patients after operation at least every 1-2 years. Conclusion Early gastric cancer patients with submucosal invasion have a high risk of recurrence, and those with paracarcinomatous mucosal medium-severe intestinal metaplasia have a low risk of recurrence. The patients with paracarcinomatous mucosal medium-severe intestinal metaplasia and cancer recurrence are feasible for a curative resection. The follow-up examinations including endoscopy every 1 or 2 years contributed highly to finding an early recurrent cancer in the remnant stomach. But it is not so helpful to increase the possibility of a curative surgery in patients with recurrence and metastasis after gastrectomy.