Clinical significance of the discrepancy between preoperative and postoperative diagnoses in gastric cancer patients.
BACKGROUND
Discrepancies between pre- and postoperative diagnoses can lead to dilemma for operative management adequacy.


METHODS
A total of 2,910 patients with gastric adenocarcinoma underwent curative surgery at the Samsung Medical Center between 2001 and 2003. Patients were divided into four groups: early gastric cancer (EGC)-EGC group that consisted of subjects who were diagnosed as having EGC pre- and postoperatively, advanced gastric cancer (AGC)-EGC group, EGC-AGC group, and AGC-AGC group. Clinicopathologic features and survival rates of groups were analyzed retrospectively.


RESULTS
Of the 2,910 patients, 1,491 (51.2%) patients were included in the EGC-EGC group, 132 (4.5%) in the AGC-EGC group, 120 (4.1%) in the EGC-AGC group, and 1,167 (40.1%) in the AGC-AGC group. The EGC-AGC group showed higher proportions of the followings than the EGC-EGC group: upper-third and middle-third tumor localizations, a tumor size from 2 to 5 cm, undifferentiated adenocarcinoma, Lauren's diffuse type, endolymphatic invasion, vascular invasion, and perineural invasion. Five-year survival rates were dependent on the final pathologic stages, not on the preoperative stages. Multivariate analysis revealed that age and American Joint Committee of Cancer stage were independent prognostic factors of patient survival.


CONCLUSIONS
A decision regarding minimally invasive treatment for EGC must be made having considered tumor location, size, and cellular differentiation, because of the possibility of an incorrect preoperative diagnosis.
Shin
Suk Hee
SH
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Bae
Jae Moon
JM
Jung
Hun
H
Choi
Min Gew
MG
Lee
Jun Haeng
JH
Noh
Jae Hyung
JH
Sohn
Tae Sung
TS
Kim
Sung
S
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed