Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: does surgery play a role?
OBJECTIVE
To evaluate the role of surgical treatment for isolated loco-regional recurrences of operated gastric adenocarcinoma.


METHODS
Among the 837 patients operated for gastric adenocarcinoma between December 1979 and April 2004, 713 (85%) underwent resection with curative intent. A retrospective review of a prospectively collected gastric cancer database was carried out. Overall recurrence rate was 44% (315 cases), with 75% occurring within the first 2 years from the operation. Isolated L-R recurrences were observed in 38 (12%) patients. Symptomatic lesions were observed in 27 (71%).


RESULTS
Six (16%) patients were macroscopically resected with curative intent. The recurrence was located in the gastric stump after a STG in three patients, in the esophagojejunal anastomosis after a TG in two patients and in the gastric bed after a TG in one patient. Surgical procedures consisted of three secondary TG, two esophagojejunal resection and one excision of an extraluminal recurrence. Postoperative complications occurred in two patients (33%), including one anastomotic leakage and one hemorrhage. The latter patient died of sepsis 35 d after the surgery (mortality rate 17%). All patients died of recurrent gastric cancer: 2 within 1 year from surgery (8 and 11 mo, respectively), 2 after 16 and 17 mo respectively and 1 after 28 mo from the second operation.


CONCLUSIONS
Surgery plays a very limited role in the treatment for isolated loco-regional recurrence of gastric adenocarcinoma.
Carboni
Fabio
F
Department of Digestive Surgery and Liver Transplantation, Regina Elena Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy. fabiocarb@tiscali.it
Lepiane
Pasquale
P
Santoro
Roberto
R
Lorusso
Riccardo
R
Mancini
Pietro
P
Carlini
Massimo
M
Santoro
Eugenio
E
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome