title: Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy: reliable results following long-term follow-up.
abstract: BACKGROUND
  To clarify the patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy.
  
  
  METHODS
  From January 1999 to March 2012, 577 patients underwent laparoscopic or laparoscopy-assisted gastrectomy for curative resection of gastric cancer. Recurrence patterns were classified as locoregional, hematogenous, peritoneal, distant lymph node and mixed. Recurrence patterns and time to recurrence were retrospectively examined and risk factors for recurrence were analyzed.
  
  
  RESULTS
  Recurrence occurred in 28 (4.9%) cases with patterns as follows: locoregional in 2 patients (7.1%), hematogenous in seven (25.0%), peritoneal in nine (32.1%), distant lymph node in four (14.3%), and mixed in 6 (21.4%). There was no recurrence pattern peculiar to laparoscopic surgery. Recurrence occurred at one site in 21 patients (78.6%), two in 4 patients (14.3%), and three in 2 patients (7.1%). The median time to recurrence was 384 days (range 83-1497 days). Recurrence was detected within a year in 13 cases (46.4%), within two years in 21 (75%), and within three years in 25 (89.3%). Univariate analysis revealed tumor location, tumor size, type of operation, tumor depth, and lymph node classification as risk factors for recurrence. Multivariate analysis indicated tumor depth and lymph node classification as risk factors of recurrence.
  
  
  CONCLUSIONS
  Patterns, timing and risk factors of recurrence of gastric cancer after laparoscopic gastrectomy are similar to those after open gastrectomy, with no peculiarities specific to laparoscopic gastrectomy. Thus, as long as laparoscopic gastrectomy is performed according to the present inclusion criteria, follow-up can be similarly performed as for open gastrectomy.
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan. Electronic address: m-nakagawa.srg2@tmd.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Center for Minimally Invasive Surgery, Tokyo Medical Dental University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Inokuchi
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sugita
authors.affiliation: Department of Esophagogastric Surgery, Tokyo Medical Dental University, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Department of Surgical Oncology, Graduate School, Tokyo Medical Dental University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Sugihara
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D047368:Tumor Burden
keywords: Gastric cancer; Laparoscopic gastrectomy; Patterns; Recurrence; Risk factor; Timing